George Nicholas, Consunji Gabriel, Storkersen Jordan, Dong Fanglong, Archambeau Benjamin, Vara Richard, Serrano Jan, Hajjafar Reza, Tran Louis, Neeki Michael M
Department of Emergency Medicine, Arrowhead Regional Medical Center, 400 N. Pepper Ave., Colton, CA, 92324, USA.
California University of Science and Medicine, 1501 Violet St., Colton, CA, 92324, USA.
Int J Emerg Med. 2022 May 30;15(1):24. doi: 10.1186/s12245-022-00427-3.
Emergent cricothyrotomy (EC) is a rare and lifesaving procedure to secure a difficult airway when other methods have failed. Many techniques have been discussed in the literature. This study aimed to identify major techniques used to perform EC in a regional trauma center and evaluate outcomes associated with the techniques.
Patients who underwent EC at Arrowhead Regional Medical Center between 1-1-2009 and 1-1-2019 were reviewed for eligibility for this study. Patients' data were extracted from the trauma database. Chi-square tests were conducted to assess the difference on variables between the techniques.
A total of 51 (0.17%) of these patients required EC and were included in the database. The two most prevalent techniques were the scalpel-bougie-tube (SBT) and the surgical cricothyrotomy technique (SCT). More than half (n = 27, 52.9%) of the cohort received the SBT. There was no statistically significant difference between the two techniques with regards to demographic variables, including age (p = 0.7528), injury severity score (ISS, p = 0.896), gender (p = 0.3709), and race (p = 0.8935). However, the SCT group had a statistically higher Glasgow Coma Scale (GCS) than the SBT group (p = 0.0036). There was no statistically significant difference in mortality or complications between these two groups (p = 0.2172 for mortality).
Two techniques of EC were identified as preferred techniques. Both procedures were successful in securing an emergency airway, noting a difference in the time to completion of the two techniques. Given the rarity of the procedure, practitioners may choose the method based on their training and the availability of appropriate instruments.
紧急环甲膜切开术（EC）是一种罕见但能挽救生命的手术，用于在其他方法均告失败时确保建立困难气道。文献中已讨论了多种技术。本研究旨在确定在某地区创伤中心进行紧急环甲膜切开术所使用的主要技术，并评估与这些技术相关的结果。
回顾2009年1月1日至2019年1月1日期间在箭头区域医疗中心接受紧急环甲膜切开术的患者，以确定其是否符合本研究的纳入标准。患者数据从创伤数据库中提取。进行卡方检验以评估不同技术之间变量的差异。
这些患者中共有51例（0.17%）需要紧急环甲膜切开术，并被纳入数据库。两种最常用的技术是手术刀-探条-气管导管（SBT）法和手术环甲膜切开术（SCT）。超过一半（n = 27，52.9%）的队列接受了SBT法。在人口统计学变量方面，包括年龄（p = 0.7528）、损伤严重程度评分（ISS，p = 0.896）、性别（p = 0.3709）和种族（p = 0.8935），这两种技术之间无统计学显著差异。然而，SCT组的格拉斯哥昏迷量表（GCS）评分在统计学上高于SBT组（p = 0.0036）。两组之间的死亡率或并发症无统计学显著差异（死亡率p = 0.2172）。
确定了两种紧急环甲膜切开术技术为首选技术。两种手术均成功建立了紧急气道，注意到两种技术完成时间存在差异。鉴于该手术的罕见性，从业者可根据自身培训情况和合适器械的可用性选择方法。
