Cargando…

Prehospital cricothyrotomies in a helicopter emergency medical service: analysis of 19,382 dispatches

BACKGROUND: Creating a patent airway by cricothyrotomy is the ultimate maneuver to allow oxygenation (and ventilation) of the patient. Given the rarity of airway management catastrophes necessitating cricothyrotomy, sufficiently sized prospective randomized trials are difficult to perform. Our Helic...

Descripción completa

Detalles Bibliográficos
Autores principales: Schober, Patrick, Biesheuvel, Tessa, de Leeuw, Marcel A., Loer, Stephan A., Schwarte, Lothar A.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BioMed Central 2019
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6343329/
https://www.ncbi.nlm.nih.gov/pubmed/30674276
http://dx.doi.org/10.1186/s12873-019-0230-9
_version_ 1783389264909697024
author Schober, Patrick
Biesheuvel, Tessa
de Leeuw, Marcel A.
Loer, Stephan A.
Schwarte, Lothar A.
author_facet Schober, Patrick
Biesheuvel, Tessa
de Leeuw, Marcel A.
Loer, Stephan A.
Schwarte, Lothar A.
author_sort Schober, Patrick
collection PubMed
description BACKGROUND: Creating a patent airway by cricothyrotomy is the ultimate maneuver to allow oxygenation (and ventilation) of the patient. Given the rarity of airway management catastrophes necessitating cricothyrotomy, sufficiently sized prospective randomized trials are difficult to perform. Our Helicopter Emergency Medical Service (HEMS) documents all cases electronically, allowing a retrospective analysis of a larger database for all cases of prehospital cricothyrotomy. METHODS: We analyzed all 19,382 dispatches of our HEMS ‘Lifeliner 1’, since set-up of a searchable digital database. This HEMS operates 24/7, covering ~ 4.5 million inhabitants of The Netherlands. The potential cases were searched and cross-checked in two independent databases. RESULTS: We recorded n = 18 cases of prehospital cricothyrotomy. In all 18 cases, less invasive airway techniques, e.g., supraglottic devices, were attempted before cricothyrotomy. With exception of 2 cases, at least one attempt of orotracheal intubation had been performed before cricothyrotomy. Out of the 18 cases, 4 were performed by puncture-based technique (Melker), the remaining 14 cases by surgical technique. Indications for cricothyrotomy were diverse, dividable into 9 trauma cases and 9 medical cases. The procedure was successful in all but one case (17/18, i.e., 94%; with a 95% confidence interval of 72.7–99.9%). Outcome was such that 6/18 patients arrived at the hospital alive. Long term outcome was poor, with only 2/18 patients discharged from hospital alive. CONCLUSIONS: Cricothyrotomy remains, although rare, a regularly occurring requirement in (H)EMS. Our finding of a convincingly high success rate of 94% in trained hands encourages training and a timely performance of cricothyrotomy.
format Online
Article
Text
id pubmed-6343329
institution National Center for Biotechnology Information
language English
publishDate 2019
publisher BioMed Central
record_format MEDLINE/PubMed
spelling pubmed-63433292019-01-24 Prehospital cricothyrotomies in a helicopter emergency medical service: analysis of 19,382 dispatches Schober, Patrick Biesheuvel, Tessa de Leeuw, Marcel A. Loer, Stephan A. Schwarte, Lothar A. BMC Emerg Med Research Article BACKGROUND: Creating a patent airway by cricothyrotomy is the ultimate maneuver to allow oxygenation (and ventilation) of the patient. Given the rarity of airway management catastrophes necessitating cricothyrotomy, sufficiently sized prospective randomized trials are difficult to perform. Our Helicopter Emergency Medical Service (HEMS) documents all cases electronically, allowing a retrospective analysis of a larger database for all cases of prehospital cricothyrotomy. METHODS: We analyzed all 19,382 dispatches of our HEMS ‘Lifeliner 1’, since set-up of a searchable digital database. This HEMS operates 24/7, covering ~ 4.5 million inhabitants of The Netherlands. The potential cases were searched and cross-checked in two independent databases. RESULTS: We recorded n = 18 cases of prehospital cricothyrotomy. In all 18 cases, less invasive airway techniques, e.g., supraglottic devices, were attempted before cricothyrotomy. With exception of 2 cases, at least one attempt of orotracheal intubation had been performed before cricothyrotomy. Out of the 18 cases, 4 were performed by puncture-based technique (Melker), the remaining 14 cases by surgical technique. Indications for cricothyrotomy were diverse, dividable into 9 trauma cases and 9 medical cases. The procedure was successful in all but one case (17/18, i.e., 94%; with a 95% confidence interval of 72.7–99.9%). Outcome was such that 6/18 patients arrived at the hospital alive. Long term outcome was poor, with only 2/18 patients discharged from hospital alive. CONCLUSIONS: Cricothyrotomy remains, although rare, a regularly occurring requirement in (H)EMS. Our finding of a convincingly high success rate of 94% in trained hands encourages training and a timely performance of cricothyrotomy. BioMed Central 2019-01-23 /pmc/articles/PMC6343329/ /pubmed/30674276 http://dx.doi.org/10.1186/s12873-019-0230-9 Text en © The Author(s). 2019 Open Access This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.
spellingShingle Research Article
Schober, Patrick
Biesheuvel, Tessa
de Leeuw, Marcel A.
Loer, Stephan A.
Schwarte, Lothar A.
Prehospital cricothyrotomies in a helicopter emergency medical service: analysis of 19,382 dispatches
title Prehospital cricothyrotomies in a helicopter emergency medical service: analysis of 19,382 dispatches
title_full Prehospital cricothyrotomies in a helicopter emergency medical service: analysis of 19,382 dispatches
title_fullStr Prehospital cricothyrotomies in a helicopter emergency medical service: analysis of 19,382 dispatches
title_full_unstemmed Prehospital cricothyrotomies in a helicopter emergency medical service: analysis of 19,382 dispatches
title_short Prehospital cricothyrotomies in a helicopter emergency medical service: analysis of 19,382 dispatches
title_sort prehospital cricothyrotomies in a helicopter emergency medical service: analysis of 19,382 dispatches
topic Research Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6343329/
https://www.ncbi.nlm.nih.gov/pubmed/30674276
http://dx.doi.org/10.1186/s12873-019-0230-9
work_keys_str_mv AT schoberpatrick prehospitalcricothyrotomiesinahelicopteremergencymedicalserviceanalysisof19382dispatches
AT biesheuveltessa prehospitalcricothyrotomiesinahelicopteremergencymedicalserviceanalysisof19382dispatches
AT deleeuwmarcela prehospitalcricothyrotomiesinahelicopteremergencymedicalserviceanalysisof19382dispatches
AT loerstephana prehospitalcricothyrotomiesinahelicopteremergencymedicalserviceanalysisof19382dispatches
AT schwartelothara prehospitalcricothyrotomiesinahelicopteremergencymedicalserviceanalysisof19382dispatches