Pre-hospital surgical cricothyroidotomy by advanced paramedics within a UK regional ambulance service: a service evaluation

Abstract

Abstract published with permission. Introduction ‐ Surgical cricothyroidotomy, the insertion of a tracheal tube through an incision in the cricothyroid membrane, is a life-saving intervention utilised when other methods of airway management are ineffective. This evaluation aims to examine the procedural success of the intervention when performed by advanced paramedics within the North West Ambulance Service over a 4-year period. Methods ‐ A retrospective database and patient record evaluation were used, utilising internal data from the North West Ambulance Service. Patients who underwent pre-hospital surgical cricothyroidotomy performed by a North West Ambulance Service advanced paramedic between November 2012 and April 2017 were included. Indications for use, patient demographics, time to insertion and overall success rate data were collected. Results ‐ Pre-hospital surgical cricothyroidotomy was performed on a total of 36 occasions. Medical cardiac arrest accounted for 18 (50%) and traumatic cardiac arrest for 12 (33%) of the interventions. The remaining interventions were performed on patients with cardiac output at the time of the intervention: five (14%) traumatic aetiology and one (3%) medical aetiology. Of the patients, 31 (86%) were male and five (14%) female. The median age was 44.5 years old; ages ranged from 9 years to 88 years old (IQR 29.75). Median time from first cut to insertion of the tracheal tube was 1 minute (range < 30 secs‐5 mins; IQR 75 secs). The overall success rate for pre-hospital surgical cricothyroidotomy was 97% (n = 35). An inability to locate anatomical landmarks was attributed to the only unsuccessful attempt secondary to foreign body airway obstruction. Discussion ‐ Surgical cricothyroidotomy was successfully performed autonomously for a variety of pre-hospital emergency aetiologies across a variety of patient demographics. The success rate (97%) of the intervention, defined as successful ventilation via a surgically inserted tracheal tube, when performed by this cohort of North West Ambulance Service advanced paramedics is highly favourable when compared with other professional groups undertaking the intervention in the pre-hospital environment.