The need to perform a surgical cricothyrotomy in the field is rare for most paramedics. Even after training for this moment, many paramedics may ask themselves if they will be up for the challenge when faced with the need to cut into the neck of a patient. It is not just about having the clinical knowledge and understanding of the anatomy, it also involves critical decision-making under stress.
The emergency procedure involves creating an opening in the cricothyroid membrane to secure an airway for patients who cannot be ventilated through less invasive means. It is typically performed when traditional airway management methods, such as intubation, are unsuccessful or impractical due to obstructions or injuries. This procedure is reserved for the most critical situations, often arising in the aftermath of traumatic injuries, severe allergic reactions, or acute airway obstructions.
The latest episode of “EMS Research with Professor Bram” gives a deeper look into the reality of performing a surgical cricothyrotomy in the field as a paramedic.1 Dr. Casey Patrick, an ER and EMS physician from Texas, talks about a recent study he helped publish that looked at how successfully surgical cricothyrotomy can be performed by paramedics.2
The study analyzed 31 cases where paramedics performed surgical cricothyrotomies over a decade within a large suburban EMS system. On average, they completed the procedure in 17 minutes. This timing started from the moment the patient was contacted and included all steps, such as assessing and attempting other airway methods like intubation, before securing final airway confirmation.
During the interview about the study, Dr. Patrick was questioned about his concerns for paramedics who are overconfident but undertrained and he acknowledges, yes, this is a concern. However, he describes a situation where there is no time to call for permission or orders. “This is an emergency with a capital E,” said Dr Patrick. To tackle this problem, he goes on to say that he is thankful that he leads an organization with a culture of education and training.
“We have a model and a roadmap that we are comfortable with … we have a culture of education, we have a culture of training. That is not something we take lightly and that requires a budget,” said Dr Patrick. Obviously, not every organization has the same resources for training.
So, do studies like this give a false hope that the paramedic can get an airway? Dr. Patrick says, “the devil is in the details. If you are properly trained, if you’re credentialed, if you have scenario-based training regarding situations where surgical airway is going to be necessary. If you have a protocol that allows you to move forward with a surgical airway when it is needed. If you have foundational resuscitation and sedation protocol. There is a lot of surrounding pieces, there is not just one piece to this puzzle,” said Dr. Patrick.
To learn more about this topic check out the full interview below.
References
1. https://youtu.be/KmPzA3CXbXw
2. Lulla, A., Dickson, R., Wells, M., Gilbert, M., Keene, K. R., & Patrick, C. (2024). Prehospital Surgical Cricothyrotomy in a Ground-Based 9-1-1 EMS System: A Retrospective Review. Prehospital and Disaster Medicine, 1-4
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