Hostname: page-component-78c5997874-mlc7c Total loading time: 0 Render date: 2024-11-19T04:14:51.008Z Has data issue: false hasContentIssue false
  • English
  • Français

High Success Rate of Prehospital and En Route Cricothyroidotomy Performed in the Israel Defense Forces: 20 Years of Experience

Published online by Cambridge University Press:  08 November 2021

Eran Beit Ner Open the ORCID record for Eran Beit Ner [Opens in a new window] ,
Avishai M. Tsur Open the ORCID record for Avishai M. Tsur [Opens in a new window] ,
Roy Nadler ,
Elon Glassberg ,
Avi Benov  and
Jacob Chen Open the ORCID record for Jacob Chen [Opens in a new window]
Eran Beit Ner*
Affiliation:
Israel Defense Forces, Medical Corps, Tel Hashomer, Ramat Gan, Israel Department of Orthopedic Surgery, Yitzhak Shamir Medical Center, Zeriffin, Affiliated to Sackler School of Medicine, Tel Aviv, Israel
Avishai M. Tsur
Affiliation:
Israel Defense Forces, Medical Corps, Tel Hashomer, Ramat Gan, Israel
Roy Nadler
Affiliation:
Israel Defense Forces, Medical Corps, Tel Hashomer, Ramat Gan, Israel Department of General Surgery and Transplantation-Surgery B, Chaim Sheba Medical Center, Tel Hashomer, Affiliated to Sackler School of Medicine, Tel Aviv, Israel
Elon Glassberg
Affiliation:
Israel Defense Forces, Medical Corps, Tel Hashomer, Ramat Gan, Israel The Azrieli Faculty of Medicine, Bar-Ilan University, Safed, Israel The Uniformed Services University of the Health Sciences, Bethesda, MarylandUSA
Avi Benov
Affiliation:
Israel Defense Forces, Medical Corps, Tel Hashomer, Ramat Gan, Israel The Azrieli Faculty of Medicine, Bar-Ilan University, Safed, Israel
Jacob Chen
Affiliation:
Israel Defense Forces, Medical Corps, Tel Hashomer, Ramat Gan, Israel Medical Directorate, Ministry of Health, Jerusalem, Israel
*
Correspondence: Eran Beit Ner, MD Israel Defense Forces, Medical Corps Tel Hashomer, Ramat Gan, Israel Department of Orthopedic Surgery Yitzhak Shamir Medical Center, Zeriffin Affiliated to Sackler School of Medicine, Tel Aviv, Israel E-mail: [email protected]
Get access Rights & Permissions [Opens in a new window]

Abstract

Introduction:

Securing the airway is a crucial stage of trauma care. Cricothyroidotomy (CRIC) is often addressed as a salvage procedure in complicated cases or following a failed endotracheal intubation (ETI). Nevertheless, it is a very important skill in prehospital settings, such as on the battlefield.

Hypothesis/Problem:

This study aimed to review the Israel Defense Forces (IDF) experience with CRIC over the past two decades.

Methods:

The IDF Trauma Registry (IDF-TR) holds data on all trauma casualties (civilian and military) cared for by military medical teams since 1997. Data of all casualties treated by IDF from 1998 through 2018 were extracted and analyzed to identify all patients who underwent CRIC procedures.

Variables describing the incident scenario, patient’s characteristics, injury pattern, treatment, and outcome were extracted. The success rate of the procedure was described, and selected variables were further analyzed and compared using the Fisher’s-exact test to identify their effect on the success and failure rates. Odds Ratio (OR) was further calculated for the effect of different body part involvement on success and for the mortality after failed ETI.

Results:

One hundred fifty-three casualties on which a CRIC attempt was made were identified from the IDF-TR records. The overall success rate of CRIC was reported at 88%. In patients who underwent one or two attempts, the success rate was 86%. No difference was found across providers (physician versus paramedic). The CRIC success rates for casualties with and without head trauma were 80% and 92%, respectively (P = .06). Overall mortality was 33%.

Conclusions:

This study shows that CRIC is of merit in airway management as it has shown to have consistently high success rates throughout different levels of training, injuries, and previous attempts with ETI. Care providers should be encouraged to retain and develop this skill as part of their tool box.

Keywords

airway managementmilitary medicineregistries
Type
Original Research
Information
Prehospital and Disaster Medicine , Volume 36 , Issue 6 , December 2021 , pp. 713 - 718
Check for updates
Copyright
© The Author(s), 2021. Published by Cambridge University Press on behalf of the World Association for Disaster and Emergency Medicine

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

Footnotes

Note: AB and JC contributed equally to the manuscript and are co-last authors.

References

American College of Surgeons, Committee on Trauma. Advanced Trauma Life Support: Student Course Manual. Chicago, Illinois USA: American College of Surgeons; 2018.Google Scholar
National Association of Emergency Medical Technicians (US), American College of Surgeons, (eds). PHTLS: Prehospital Trauma Life Support. Eighth edition. Burlington, Massachusetts USA: Jones & Bartlett Learning; 2015.Google Scholar
Otten, EJ, Montgomery, HR, Butler, FK. Extra glottic airways in Tactical Combat Casualty Care: TCCC guidelines change 17-01 28 August 2017. J Spec Oper Med. 2017;17(4):19–28.Google Scholar
You-Ten, KE, Bould, MD, Friedman, Z, Riem, N, Sydor, D, Boet, S. Cricothyrotomy training increases adherence to the ASA difficult airway algorithm in a simulated crisis: a randomized controlled trial. Can J Anesth/J Can Anesth. 2015;62(5):485–494.CrossRefGoogle Scholar
Wong, DT, Prabhu, AJ, Coloma, M, Imasogie, N, Chung, FF. What is the minimum training required for successful cricothyroidotomy? A study in mannequins. Anesthesiology. 2003;98(2):349–353.CrossRefGoogle ScholarPubMed
Mabry, RL. An analysis of battlefield cricothyrotomy in Iraq and Afghanistan. J Spec Oper Med. 2012;12(1):17–23.Google ScholarPubMed
McGill, J, Clinton, JE, Ruiz, E. Cricothyrotomy in the emergency department. Ann Emerg Med. 1982;11(7):361–364.CrossRefGoogle ScholarPubMed
Erlandson, MJ, Clinton, JE, Ruiz, E, Cohen, J. Cricothyrotomy in the emergency department revisited. J Emerg Med. 1989;7(2):115–118.CrossRefGoogle ScholarPubMed
Bair, AE, Panacek, EA, Wisner, DH, Bales, R, Sakles, JC. Cricothyrotomy: a 5-year experience at one institution. J Emerg Med. 2003;24(2):151–156.CrossRefGoogle ScholarPubMed
Adams, BD, Cuniowski, PA, Muck, A, De Lorenzo, RA. Registry of emergency airways arriving at combat hospitals. J Trauma. 2008;64(6):1548–1554.Google ScholarPubMed
Langvad, S, Hyldmo, PK, Nakstad, AR, Vist, GE, Sandberg, M. Emergency cricothyrotomy--a systematic review. Scand J Trauma Resusc Emerg Med. 2013;21:43.CrossRefGoogle Scholar
Schauer, SG, Bellamy, MA, Mabry, RL, Bebarta, VS. A Comparison of the incidence of cricothyrotomy in the deployed setting to the emergency department at a Level I military trauma center: a descriptive analysis. Mil Med. 2015;180(3S):60–63.CrossRefGoogle Scholar
von Elm, E, Altman, DG, Egger, M, et al. The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) Statement: guidelines for reporting observational studies. Int J Surg. 2014;12(12):1495–1499.CrossRefGoogle ScholarPubMed
Tsur, AM, Nadler, R, Tsur, N, et al. Prehospital definitive airway is not associated with improved survival in trauma patients. J Trauma Acute Care Surg. 2020;89(2S):S237–S241.CrossRefGoogle Scholar
Shavit, I, Aviram, E, Hoffmann, Y, Biton, O, Glassberg, E. Laryngeal mask airway as a rescue device for failed endotracheal intubation during scene-to-hospital air transport of combat casualties. Eur J Emerg Med. 2018;25(5):368–371.CrossRefGoogle ScholarPubMed
ATLS Subcommittee, American College of Surgeons’ Committee on Trauma, International ATLS Working Group. Advanced Trauma Life Support (ATLS): the ninth edition. J Trauma Acute Care Surg. 2013;74(5):1363–1366.Google Scholar
Tsur, AM, Nadler, R, Lipsky, AM, et al. The Israel Defense Forces Trauma Registry: 22 years of point-of-injury data. J Trauma Acute Care Surg. 2020;89(2S):S32–S38.CrossRefGoogle ScholarPubMed
Benov Avi null, Elon, G, Baruch, EN, et al. Augmentation of point of injury care: Reducing battlefield mortality-The IDF experience. Injury. 2016;47(5):993–1000.Google Scholar
Katzenell, U, Lipsky, AM, Abramovich, A, et al. Prehospital intubation success rates among Israel Defense Forces providers: epidemiologic analysis and effect on doctrine. J Trauma Acute Care Surg. 2013;75(2 Suppl 2):S178–183.CrossRefGoogle ScholarPubMed
Shina, A, Lipsky, AM, Nadler, R, et al. Prehospital use of hemostatic dressings by the Israel Defense Forces Medical Corps: a case series of 122 patients. J Trauma Acute Care Surg. 2015;79(4 Suppl 2):S204–209.CrossRefGoogle ScholarPubMed
Nadler, R, Gendler, S, Benov, A, Strugo, R, Abramovich, A, Glassberg, E. Tranexamic acid at the point of injury: the Israeli combined civilian and military experience. J Trauma Acute Care Surg. 2014;77(3 Suppl 2):S146–150.CrossRefGoogle ScholarPubMed
Lipsky, AM, Abramovich, A, Nadler, R, et al. Tranexamic acid in the prehospital setting: Israel Defense Forces’ initial experience. Injury. 2014;45(1):66–70.CrossRefGoogle ScholarPubMed
Nadler, R, Mozer-Glassberg, Y, Gaines, B, Glassberg, E, Chen, J. The Israel Defense Forces experience with freeze-dried plasma for the resuscitation of traumatized pediatric patients. J Trauma Acute Care Surg. 2019;87(6):1315–1320.CrossRefGoogle ScholarPubMed
Lockey, D, Crewdson, K, Weaver, A, Davies, G. Observational study of the success rates of intubation and failed intubation airway rescue techniques in 7256 attempted intubations of trauma patients by pre-hospital physicians. British J Anesthesia. 2014;113(2):220–225.CrossRefGoogle ScholarPubMed
Helm, M, Hossfeld, B, Jost, C, Lampl, L, Böckers, T. Emergency cricothyroidotomy performed by inexperienced clinicians--surgical technique versus indicator-guided puncture technique. Emerg Med J. 2013;30(8):646–649.CrossRefGoogle ScholarPubMed
Barnard, EBG, Ervin, AT, Mabry, RL, Bebarta, VS. Prehospital and en route cricothyrotomy performed in the combat setting: a prospective, multicenter, observational study. J Spec Oper Med. 2014;14(4):35–39.Google ScholarPubMed
Cook, TM, Woodall, N, Frerk, C, Fourth National Audit Project. Major complications of airway management in the UK: results of the Fourth National Audit Project of the Royal College of Anesthetists and the Difficult Airway Society. Part 1: anesthesia. Br J Anaesth. 2011;106(5):617–631.CrossRefGoogle Scholar