Can nurses perform surgical cricothyrotomy with acceptable success and complication rates?

• Published in: Annals of emergency medicine Vol. 20; no. 4; pp. 367 - 370
• Main Authors: Nugent, Wendy L, Rhee, Kenneth J, Wisner, David H
• Format: Journal Article
• Language: English
• Published: New York, NY Mosby, Inc 01.04.1991; Elsevier
• Subjects: Adolescent; Adult; Aerospace Medicine; Aged; Airway Obstruction - surgery; Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy; Biological and medical sciences; Child; Clinical Competence; Cricoid Cartilage - surgery; cricothyrotomy; Education, Nursing, Continuing; Emergency and intensive respiratory care; Emergency Medical Services; Humans; Intensive care medicine; Intubation, Intratracheal; Medical sciences; Middle Aged; Nurses; Nursing Care - standards; Postoperative Complications; prehospital; Resuscitation - education; Retrospective Studies; Space life sciences; Thyroid Cartilage - surgery; Transportation of Patients; prehospital; cricothyrotomy; Human; First emergency care; Respiratory intensive care; Vocational aptitude; Surgery; Nurse
• ISSN: 0196-0644; 1097-6760
• DOI: 10.1016/S0196-0644(05)81656-7

This study was undertaken to determine whether flight nurses can perform surgical cricothyrotomies with acceptable success and complication rates. This case series examined the survival, success, and complication rates of surgical cricothyrotomy. A specially trained flight nurse retrospectively reviewed all prehospital, emergency department, inpatient, autopsy, and outpatient follow-up records. Fifty-five consecutive patients in whom surgical cricothyrotomy was attempted by a flight nurse during a two-and-one-half-year period were studied. Patients ranged in age from 9 to 76 years. The airway was not cannulated successfully by a flight nurse in two patients. In two patients, the tube was not in the cricothyroid space (one in the upper tracheal rings, and the other in the larynx). In three patients, packing was insufficient to stop bleeding from around the operative site; and in three the tube became occluded by blood in the emergency department. Finally, two patients developed subglottic stenosis. Surgical cricothyrotomy in the field can be performed reliably by specially trained nurses. Because only the most critically ill or injured patients with unmanageable airways are subjected to this procedure, a significant complication rate can be anticipated.