London's Air Ambulance, London, UK
Barts Health NHS Trust, London, UK.
Emerg Med J. 2021 May;38(5):349-354. doi: 10.1136/emermed-2020-210305. Epub 2021 Feb 17.
This study aimed to determine the rate of scalpel cricothyroidotomy conducted by a physician-paramedic prehospital trauma service over 20 years and to identify indications for, and factors associated with the intervention.
A retrospective observational study was conducted from 1 January 2000 to 31 December 2019 using clinical database records. This study was conducted in a physician-paramedic prehospital trauma service, serving a predominantly urban population of approximately 10 million in an area of approximately 2500 km.
Over 20 years, 37 725 patients were attended by the service, and 72 patients received a scalpel cricothyroidotomy. An immediate 'primary' cricothyroidotomy was performed in 17 patients (23.6%), and 'rescue' cricothyroidotomies were performed in 55 patients (76.4%). Forty-one patients (56.9%) were already in traumatic cardiac arrest during cricothyroidotomy. Thirty-two patients (44.4%) died on scene, and 32 (44.4%) subsequently died in hospital. Five patients (6.9%) survived to hospital discharge, and three patients (4.2%) were lost to follow-up. The most common indication for primary cricothyroidotomy was mechanical entrapment of patients (n=5, 29.4%). Difficult laryngoscopy, predominantly due to airway soiling with blood (n=15, 27.3%) was the most common indication for rescue cricothyroidotomy. The procedure was successful in 97% of cases. During the study period, 6570 prehospital emergency anaesthetics were conducted, of which 30 underwent rescue cricothyroidotomy after failed tracheal intubation (0.46%, 95% CI 0.31% to 0.65%).
This study identifies a number of indications leading to scalpel cricothyroidotomy both as a primary procedure or after failed intubation. The main indication for scalpel cricothyroidotomy in our service was as a rescue airway for failed laryngoscopy due to a large volume of blood in the airway. Despite high levels of procedural success, 56.9% of patients were already in traumatic cardiac arrest during cricothyroidotomy, and overall mortality in patients with trauma receiving this procedure was 88.9% in our service.
本研究旨在确定 20 多年来，医师-护理员院前创伤服务团队实施手术刀环甲切开术的比率，并确定干预的指征和相关因素。
采用回顾性观察性研究，于 2000 年 1 月 1 日至 2019 年 12 月 31 日，使用临床数据库记录进行研究。该研究在一个医师-护理员院前创伤服务团队中进行，该服务团队服务的人群主要是约 1000 万居住在面积约 2500 平方公里的城市地区的人群。
在 20 多年的时间里，该服务团队共救治了 37725 名患者，其中 72 名患者接受了手术刀环甲切开术。17 名患者（23.6%）立即进行了“主要”环甲切开术，55 名患者（76.4%）进行了“抢救”环甲切开术。41 名患者（56.9%）在进行环甲切开术时已经发生创伤性心搏骤停。32 名患者（44.4%）在现场死亡，32 名患者（44.4%）随后在医院死亡。5 名患者（6.9%）存活至出院，3 名患者（4.2%）失访。主要的环甲切开术指征是患者的机械性嵌顿（n=5，29.4%）。由于气道被血液污染（n=15，27.3%）导致喉镜检查困难，是进行抢救性环甲切开术的最常见指征。97%的病例手术成功。在研究期间，共进行了 6570 例院前急救麻醉，其中 30 例在气管插管失败后进行了抢救性环甲切开术（0.46%，95%CI 0.31%至 0.65%）。
本研究确定了一些导致手术刀环甲切开术的指征，包括主要手术或在插管失败后进行手术。在我们的服务中，手术刀环甲切开术的主要指征是作为气道不畅的抢救措施，因为气道中有大量血液。尽管手术成功率较高，但在进行环甲切开术时，56.9%的患者已经发生创伤性心搏骤停，在我们的服务中，接受该手术的创伤患者的总体死亡率为 88.9%。
