Read on Twitter
Really excited to share our paper published in @EmergencyMedBMJ!
https://emj.bmj.com/content/early/2021/02/15/emermed-2020-210305
A 20-year review of 72 prehospital scalpel cricothyroidotomies (SC) conducted by @LDNairamb.
Co-authors: Elizabeth Foster, Prof. David Lockey and @DrMikeChristian. 1/14
https://emj.bmj.com/content/early/2021/02/15/emermed-2020-210305
A 20-year review of 72 prehospital scalpel cricothyroidotomies (SC) conducted by @LDNairamb.
Co-authors: Elizabeth Foster, Prof. David Lockey and @DrMikeChristian. 1/14
We conducted a retrospective database review of 37,725 patients attended by the #HEMS service across London over a period of 20-years between Jan 2000 and Dec 2019. 2/14
The study aimed to identify indications for, and factors associated with the #prehospital scalpel cric. We also aimed to determine the rate of SC conducted by the service, and to examine changes in practice that may have affected this rate. 3/14
We identified 72 patients who received scalpel cric. Demographics/MOI are in the full paper.
An immediate 'primary' SC without attempted laryngoscopy was conducted in 17 patients (23.6%).
'Rescue' SC following failed intubation was conducted in 55 patients (76.4%). 4/14
An immediate 'primary' SC without attempted laryngoscopy was conducted in 17 patients (23.6%).
'Rescue' SC following failed intubation was conducted in 55 patients (76.4%). 4/14
The most common indication for primary scalpel cric was mechanical entrapment of patients (n = 5, 29.4%). 5/14
Difficult laryngoscopy, predominantly due to airway soiling with blood (n=15, 27.3%) was the most common indication for rescue SC. 6/14
During the study period, 6570 prehospital emergency anaesthetics (PHEA) were conducted, of which 30 underwent rescue scalpel cric after failed tracheal intubation (0.46%, 95% CI 0.31% to 0.65%). 7/14
We examined two changes in practice that may have affected the rate of rescue scalpel cric in those receiving PHEA. The introduction of supraglottic airways (ProSeal 2005, iGel 2010) and a change in PHEA agents used in 2012 (Switch to Roc, Ket, Fent from Sux and Etomidate). 8/14
The rate of scalpel cric decreased after ProSeal/iGel and longer-acting muscle relaxants were introduced to the service. However, these results may be confounded by patient factors, clinician experience and other changes in practice, which we could not measure in this study. 9/14
Thirty-two patients (44.4%) died on scene, and 32 (44.4%) subsequently died in hospital.
Five patients (6.9%) were confirmed to have survived to hospital discharge.
Three patients (4.2%) were lost to follow-up. 10/14
Five patients (6.9%) were confirmed to have survived to hospital discharge.
Three patients (4.2%) were lost to follow-up. 10/14
Overall mortality was high (88.9%) in this series.
However, forty-one patients (56.9%) were already in traumatic cardiac arrest during scalpel cric which itself carries a poor prognosis. 11/14
However, forty-one patients (56.9%) were already in traumatic cardiac arrest during scalpel cric which itself carries a poor prognosis. 11/14
Despite this, of the 72 scalpel crics performed, 70 were successful in gaining definitive airway control (97.2%) suggesting our technique of SC (scalpel, dilators/hook, bougie, tube) which doesn't use scalpel rotation, is effective and has a high rate of procedural success. 12/14
A few acknowledgements and thanks:
Data was kindly provided by @LDNairamb @NHSBartsHealth @Ldn_Ambulance. We would like to extend our thanks to these teams for their support with this project and to all the clinicians providing care for the patients during this study. 13/14
Data was kindly provided by @LDNairamb @NHSBartsHealth @Ldn_Ambulance. We would like to extend our thanks to these teams for their support with this project and to all the clinicians providing care for the patients during this study. 13/14
A personal thanks to my co-authors and @rupert_pearse for the opportunity to conduct this study as part of my AFP rotation in Critical Care.
Special thanks to my supervisor @DrMikeChristian for your patience, guidance and continued mentorship over this past year. 14/14
Special thanks to my supervisor @DrMikeChristian for your patience, guidance and continued mentorship over this past year. 14/14
