(297) Long-term outcomes of cricothyroidotomy: A retrospective comparative analysis cohort study

Introduction: Cricothyroidotomy (CRIC) is a salvage procedure commonly used in failed
endotracheal intubation (ETI) or difficult airway cases. However, more data is needed
regarding the short and long-term complications associated with CRIC. This study
aimed to evaluate the Israel Defense Forces (IDF) experience with CRIC over the past
two decades and compare the short-term and long-term sequelae of prehospital CRIC
and ETI.

Methods: Data on patients undergoing either CRIC or ETI in the prehospital setting
between 1997-2021 were extracted from the IDF trauma registry. Patient data was
then cross-referenced with the Israel national trauma registry, documenting in-hospital
care, and the Israel Ministry of Defense rehabilitation department registry, containing
long-term disability files of military personnel.

Results: Of the 122 patients with short-term follow-up through initial hospitalization,
81% underwent prehospital ETI, while 19% underwent CRIC. There was a higher
prevalence of military-related and explosion injuries among the CRIC patients (96%
vs. 65%, p=0.02). Patients who underwent CRIC more frequently exhibited oxygen
saturations below 90% (52% vs. 29%, p=0.002). Injury Severity Score was
comparable between groups.
No significant difference was found in ICU length of stay and need for tracheostomy.
Regarding long-term complications, with a median follow-up time of 15 years, CRIC
patients had more upper airway impairment, with most suffering from hoarseness
alone.

Conclusions: This retrospective comparative analysis did not reveal significant short
or long-term sequala who underwent prehospital CRIC. The
long-term follow-up did not indicate severe aerodigestive impairments, thus
suggesting that this technique is safe. Along with the high success rates attributed to
this procedure, we recommend that CRIC remains in the armamentarium of trauma
care providers.