Cricothyrotomy, an emergency airway procedure through the cricoid membrane, has been used in emergency and prehospital settings since the 1980s. Due to its rarity and high risk of error, it is considered a high-risk, low-occurrence procedure. Understanding when EMS performs cricothyrotomy is crucial to improving training and prehospital airway care.
Several studies have examined prehospital cricothyrotomy with varied outcomes. Fortune et al. reported 56 cases with 64% acceptable airways on hospital arrival and 62% survival to emergency discharge after EMS crews trained biannually using animal models. Schober et al. found a 94% procedure success rate but only 33% survival to hospital arrival in a Dutch helicopter EMS programme (18 cases). Aziz et al. reviewed 72 cases over 20 years with a 97% success rate, noting that 56.9% of patients were in cardiac arrest during the procedure. Aside from military studies, no large multicentre civilian studies exist, prompting the use of a large U.S. EMS database to analyse current prehospital cricothyrotomy trends.
This study analysed data from the National Emergency Medical Services Information System, a large U.S. registry with over 100 million EMS patient reports. It focused on adult patients (over 18) who underwent any form of cricothyrotomy by EMS between January 1, 2022, and December 31, 2023. Cases involving air ambulances or interfacility transfers were excluded. The study also analysed cricothyrotomy success rates by patient race/ethnicity and sex, addressing known disparities in tracheal intubation outcomes.
Out of nearly 59.6 million EMS activations surveyed, 1,136 adult prehospital cricothyrotomies met inclusion criteria. The majority were performed on males (72.4%) and patients aged 60 or younger (66.2%). Nearly half (47.2%) of these patients were in cardiac arrest upon EMS arrival. The most common dispatch reasons were cardiac arrest/death (23.0%), traffic/transportation incidents (16.2%), and stab or gunshot wounds (12.2%). Most patients (73.7%) who underwent cricothyrotomy were transported by EMS.
Prehospital cricothyrotomies were successful in 83.3% of cases overall. Success rates showed no significant differences between males (81.8%) and females (84.0%), nor between White patients (85.4%) and Black or African American (85.7%) or Hispanic or Latino patients (80.0%).
This study highlights current trends in prehospital cricothyrotomies in the U.S., confirming it is a rare procedure with only 1,136 cases among nearly 60 million EMS activations. Key findings include that most procedures were performed on male patients and those aged 60 or younger. Additionally, nearly half of the patients were in cardiac arrest when EMS arrived, with “Cardiac Arrest/Death” of unknown cause being the most common dispatch reason.
The study found an 83.3% success rate for prehospital cricothyrotomy, which is higher than reported success rates for prehospital tracheal intubation (around 75-77%). While previous research showed demographic disparities in tracheal intubation success—lower rates for females and non-White patients—this study found no significant differences in cricothyrotomy success based on patient sex or race.
Source: Chest
Image Credit: iStock
References:
Shekhar AC et al. (2025) Prehospital Cricothyrotomy for Emergency Airway Management. Chest. 167(6):1684-1686.
