Pre-morbid Commonalities Among Patients Undergoing Emergent Cricothyrotomy at a Tertiary Care Level 1 Trauma Center: Categorizing Our Experience

TL;DR

This study identifies common health conditions and risk factors in patients who needed an emergency cricothyrotomy, aiming to improve recognition of difficult intubation cases.

Contribution

The paper highlights pre-morbid conditions and clinical factors associated with the need for cricothyrotomy in a trauma center setting.

Findings

Chronic obstructive pulmonary disease (COPD) and asthma were common pre-morbid conditions among patients.

Airway edema and blood were the main factors preventing intubation and leading to cricothyrotomy.

Patients with distorted airway anatomy due to malignancy or surgery were at higher risk for failed intubation.

Abstract

Introduction: Emergent cricothyrotomy is a lifesaving surgical procedure employed when conventional intubation fails. Scenarios requiring cricothyrotomy are uncommon, and many trainees have limited experience with the procedure. As “cannot intubate, cannot oxygenate” (CICO) scenarios demand rapid intervention, it is crucial that providers are able to determine which patients are at risk for failed intubation and, when necessary, quickly proceed to a surgical airway. This study investigates pre-morbid commonalities among patients who underwent cricothyrotomy at a tertiary care level 1 trauma center to improve the identification of difficult intubation scenarios that may require cricothyrotomy.

Methods: A retrospective analysis of the demographic, clinical, and procedural data of 32 patients who underwent emergent cricothyrotomy at our institution between 2014 and 2025 was performed. Descriptive statistics were analyzed to characterize the patient cohort.

Results: Common pre-morbid conditions in our series included chronic obstructive pulmonary disease (COPD), asthma, and head and neck cancer. The leading indications for attempted intubation were angioedema, obstructive tumor, trauma, and acute respiratory failure. Laryngoscopy revealed airway edema and blood as the primary factors obscuring the airway, preventing intubation and prompting the need for cricothyrotomy.

Conclusion: Patients with limited respiratory reserve capacity, such as in COPD and asthma, as well as those with distorted airway anatomy secondary to malignancy, radiation fibrosis, or post-surgical changes, are at higher risk for failed intubation attempts leading to eventual cricothyrotomy. The early recognition of risk factors may lead to improved airway management planning, which, in some cases, may mitigate the need for emergent cricothyrotomy.