Outcomes of emergency surgical airway procedures in a hospital-wide setting

Objective: To review the circumstances, complications, and outcomes of emergency surgical airway procedures and to compare the relative merits of cricothyroidotomy and tracheotomy for airway control in a hospital-wide patient population. Study Design: Retrospective review. Methods: Patient data were obtained from the inpatient charts and electronic patient records of 35 patients who required an emergency surgical airway over a 6-year period at an urban medical center. Results: Emergency cricothyroidotomy and tracheotomy were successfully performed in 34 of 35 patients (97%). Orotracheal intubation was successfully achieved in one patient with a failed cricothyroidotomy. The overall complication rates for emergency cricothyroidotomy and tracheotomy were similar (20% and 21%, respectively). Inpatients requiring an emergency surgical airway had a higher complication rate (32% vs. 0%) but better overall survival (91% vs. 46%) than patients treated in the emergency department. No long-term complications were observed from emergency cricothyroidotomies that were not converted to tracheotomies. Conclusion: The establishment of an emergency surgical airway by either tracheotomy or cricothyroidotomy is effective with low overall morbidity. The need to convert every emergency cricothyroidotomy to a tracheotomy should be reevaluated.