Xeropotamos N S, Coats T J, Wilson A W
Royal London Hospital, London, UK.
Injury. 1993 Apr;24(4):222-4. doi: 10.1016/0020-1383(93)90172-3.
Advanced Trauma Life Support requires surgical airway techniques to be used in patients when oral or nasal intubation is impossible or contraindicated. Few reports have examined the results of surgical cricothyroidotomy in prehospital trauma management. During a 12-month period, 600 patients were seen and treated by the Helicopter Emergency Medical Service medical team. Advanced airway techniques were performed at the scene in 143 cases (24 per cent). Of these cases, orotracheal intubation was performed in 132 (92.3 per cent) and surgical cricothyroidotomy in 11 (7.7 per cent). The indications for cricothyroidotomy were: (1) failed intubation in patients with facial injuries, (2) intubation impossible due to patient position during entrapment, and (3) severe burns. Four patients, who were already in cardiopulmonary arrest, succumbed in the field despite cricothyroidotomy. Three patient later died in hospital and four (37 per cent) survived. Three of the survivors made a good recovery, including one who was in cardiorespiratory arrest at the scene, and one remains severely disabled. Surgical cricothyroidotomy is a life-saving procedure in prehospital trauma management that must be performed without delay or hesitation if conventional airway manoeuvres are impossible or fail.
高级创伤生命支持要求在无法进行口腔或鼻腔插管或存在禁忌证的患者中使用外科气道技术。很少有报告探讨院前创伤管理中外科环甲膜切开术的结果。在12个月的期间内，直升机紧急医疗服务医疗队诊治了600例患者。143例（24%）在现场实施了高级气道技术。在这些病例中，132例（92.3%）进行了经口气管插管，11例（7.7%）进行了外科环甲膜切开术。环甲膜切开术的适应证为：（1）面部损伤患者插管失败，（2）被困期间因患者体位无法插管，（3）严重烧伤。4例已经发生心肺骤停的患者，尽管进行了环甲膜切开术，仍在现场死亡。3例患者后来在医院死亡，4例（37%）存活。3名幸存者恢复良好，包括1例在现场发生心肺骤停的患者，1例仍严重残疾。外科环甲膜切开术是院前创伤管理中的一种挽救生命的操作，如果传统气道操作无法进行或失败，必须立即毫不犹豫地进行。
