Abstract
BackgroundCricothyroidotomy and surgical tracheostomy are methods to secure airway patency. In emergency surgery, these methods are nowadays mostly reserved for patients unsuited for percutaneous procedures. Detailed description of complications and functional outcomes following both procedures is underreported in current literature. The aim of this study was to evaluate outcomes following cricothyroidotomy and tracheostomy in this presumed complex population.MethodsIn this retrospective cohort study, adult emergency surgical patients treated with cricothyroidotomy and/or surgical tracheostomy were included. Postoperative complications and functional outcomes in trauma and non-trauma patients were evaluated.ResultsForty-one trauma patients and 11 non-trauma emergency surgical patients (mainly after elective onco-abdominal or vascular surgery) were included. Of 52 patients, seven underwent cricothyroidotomy pre-tracheostomy. Mortality was higher in non-trauma patients (p = 0.04) following both procedures. Over half of patients (56%, n = 29) regained unsupported airway patency with a tendency toward increased tracheostomy removal in trauma patients. Among complications, only pneumonia occurred frequently (60%, n = 31), with no relation to patient type. Other complications included local infection (5.8%, n = 4) and wound dehiscence (1.9%, n = 1). Adverse functional outcomes were frequently observed and were mild and self-limiting. Cervical spinal cord injury reduced overall unsupported airway patency (p = 0.01); with high cervical spinal cord injury related to adverse functional outcomes and increased home ventilation need.ConclusionsNo major procedure-related complications or functional adverse events were encountered following cricothyroidotomy and surgical tracheostomy, even though only complex patients were included. Only mild, self-limiting functional problems occurred, especially in trauma patients with cervical injury who underwent early tracheostomy by longitudinal incision. This information can aid clinicians in making tailor-made decisions for individual patients.
Highlights
Cricothyroidotomy and tracheostomy are both surgical methods to secure patency of the airway
The aim of this study was to evaluate outcomes following cricothyroidotomy and tracheostomy in this presumed complex population. In this retrospective cohort study, adult emergency surgical patients treated with cricothyroidotomy and/or surgical tracheostomy were included
This study provided a detailed description of short- and long-term clinical outcomes following surgical airway procedures in emergency surgical patients, in a time where these procedures are reserved for patients unsuited for percutaneous procedures
Summary
Cricothyroidotomy and tracheostomy are both surgical methods to secure patency of the airway. Cricothyroidotomy is performed in the emergency setting and provides an alternative method of gaining airway access when endotracheal intubation fails. Considering the emergency setting, it is not surprising cricothyroidotomy is prone to cause severe short-term complications, including upper airway laceration, posterior tracheal perforation and nerve damage [1, 2]. Due to its rare nature, knowledge about long-term outcomes following cricothyroidotomy is scarce. Cricothyroidotomy and surgical tracheostomy are methods to secure airway patency. In emergency surgery, these methods are nowadays mostly reserved for patients unsuited for percutaneous procedures. The aim of this study was to evaluate outcomes following cricothyroidotomy and tracheostomy in this presumed complex population
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