Surgical Cricothyrotomy vs. Endotracheal Intubation: A Study of Long-Term Disability Outcomes
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Using IDF trauma and long-term disability databases from 1997 to 2021, researchers reviewed 19 surgical cricothyrotomies performed prehospital by paramedics or MDs (using a 6 mm Portex tracheostomy tube and scalpel) compared to 81 endotracheal intubations (ETI) who were awarded long term disability for an airway related reason.
21% of surgical airways had long term disability for hoarseness (3) or voice changes (1). The authors did identified one additional cric casualty with esophageal stricture limiting them to only drinking liquids, but acknowledged that could have been from the original injury and not the cricothyrotomy. Only one ETI casualty had an upper airway impairment disability claim. No subglottic stenosis occurred in either group.
In 62% of surgical airway casualties the procedure was indicated secondary to face / head deformity. Only, 23% of cricothyrotomies and 10% of ETI casualties went on to tracheostomy in the hospital.
Casualties undergoing surgical airway placement were more frequently explosively injured 57.7% vs 25%, less frequently injured in motor vehicle crashes 7.7% vs 20%, more likely to have heart rates over 130, 65% vs 40%, and more likely to have oxygen saturations <90%, 50% vs 29%.
There was no statistically significant difference in groups between injury severity scores, hospital length of stay, intensive care unit length of stay, or discharge destination.
The authors concluded short or long term surgical cricothyrotomy related disability was insignificant.
Although a 21% rate of long-term hoarseness or voice changes does seems acceptable with significant head / face trauma, hypoxia, and tachycardia, this data also re-enforces that the procedure is more invasive and comes with higher airway related disability compared to endotracheal intubation.
Conclusion
However, if supplemental oxygen, rapid sequence intubation medications, adequate medications for sedation, quality suction, and a skilled intubator aren’t available, it remains the definitive airway of choice.
References
Tsur N, Talmy T, Rittblat M, Radomislensky I, Almog O, Gendler S. Long-Term Outcomes of Cricothyroidotomy Versus Endotracheal Intubation in Military Personnel: A Retrospective Comparative Analysis Cohort Study. J Surg Res. 2024 Aug;300:416-424. doi: 10.1016/j.jss.2024.05.015. Epub 2024 Jun 7. Erratum in: J Surg Res. 2024 Sep;301:247. doi: 10.1016/j.jss.2024.06.004. PMID: 38851087.
