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High Success Rate of Prehospital and En Route Cricothyroidotomy Performed in the Israel Defense Forces: 20 Years of Experience

Published online by Cambridge University Press:  08 November 2021

Eran Beit Ner Open the ORCID record for Eran Beit Ner [Opens in a new window] ,
Avishai M. Tsur Open the ORCID record for Avishai M. Tsur [Opens in a new window] ,
Roy Nadler ,
Elon Glassberg ,
Avi Benov  and
Jacob Chen Open the ORCID record for Jacob Chen [Opens in a new window]
Eran Beit Ner*
Affiliation:
Israel Defense Forces, Medical Corps, Tel Hashomer, Ramat Gan, Israel Department of Orthopedic Surgery, Yitzhak Shamir Medical Center, Zeriffin, Affiliated to Sackler School of Medicine, Tel Aviv, Israel
Avishai M. Tsur
Affiliation:
Israel Defense Forces, Medical Corps, Tel Hashomer, Ramat Gan, Israel
Roy Nadler
Affiliation:
Israel Defense Forces, Medical Corps, Tel Hashomer, Ramat Gan, Israel Department of General Surgery and Transplantation-Surgery B, Chaim Sheba Medical Center, Tel Hashomer, Affiliated to Sackler School of Medicine, Tel Aviv, Israel
Elon Glassberg
Affiliation:
Israel Defense Forces, Medical Corps, Tel Hashomer, Ramat Gan, Israel The Azrieli Faculty of Medicine, Bar-Ilan University, Safed, Israel The Uniformed Services University of the Health Sciences, Bethesda, MarylandUSA
Avi Benov
Affiliation:
Israel Defense Forces, Medical Corps, Tel Hashomer, Ramat Gan, Israel The Azrieli Faculty of Medicine, Bar-Ilan University, Safed, Israel
Jacob Chen
Affiliation:
Israel Defense Forces, Medical Corps, Tel Hashomer, Ramat Gan, Israel Medical Directorate, Ministry of Health, Jerusalem, Israel
*
Correspondence: Eran Beit Ner, MD Israel Defense Forces, Medical Corps Tel Hashomer, Ramat Gan, Israel Department of Orthopedic Surgery Yitzhak Shamir Medical Center, Zeriffin Affiliated to Sackler School of Medicine, Tel Aviv, Israel E-mail: eranbnster@gmail.com
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Abstract

Introduction:

Securing the airway is a crucial stage of trauma care. Cricothyroidotomy (CRIC) is often addressed as a salvage procedure in complicated cases or following a failed endotracheal intubation (ETI). Nevertheless, it is a very important skill in prehospital settings, such as on the battlefield.

Hypothesis/Problem:

This study aimed to review the Israel Defense Forces (IDF) experience with CRIC over the past two decades.

Methods:

The IDF Trauma Registry (IDF-TR) holds data on all trauma casualties (civilian and military) cared for by military medical teams since 1997. Data of all casualties treated by IDF from 1998 through 2018 were extracted and analyzed to identify all patients who underwent CRIC procedures.

Variables describing the incident scenario, patient’s characteristics, injury pattern, treatment, and outcome were extracted. The success rate of the procedure was described, and selected variables were further analyzed and compared using the Fisher’s-exact test to identify their effect on the success and failure rates. Odds Ratio (OR) was further calculated for the effect of different body part involvement on success and for the mortality after failed ETI.

Results:

One hundred fifty-three casualties on which a CRIC attempt was made were identified from the IDF-TR records. The overall success rate of CRIC was reported at 88%. In patients who underwent one or two attempts, the success rate was 86%. No difference was found across providers (physician versus paramedic). The CRIC success rates for casualties with and without head trauma were 80% and 92%, respectively (P = .06). Overall mortality was 33%.

Conclusions:

This study shows that CRIC is of merit in airway management as it has shown to have consistently high success rates throughout different levels of training, injuries, and previous attempts with ETI. Care providers should be encouraged to retain and develop this skill as part of their tool box.

Keywords

airway managementmilitary medicineregistries
Type
Original Research
Information
Prehospital and Disaster Medicine , Volume 36 , Issue 6 , December 2021 , pp. 713 - 718
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Copyright
© The Author(s), 2021. Published by Cambridge University Press on behalf of the World Association for Disaster and Emergency Medicine

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Footnotes

Note: AB and JC contributed equally to the manuscript and are co-last authors.

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