Abstract：
BACKGROUND: Emergency airway management is critical in trauma care. 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 experience with CRIC over the past 2 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 and 2021 were extracted from the Israel Defense Forces 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% versus 65%, P = 0.02). Patients who underwent CRIC more frequently exhibited oxygen saturations below 90% (52% versus 29%, P = 0.002). Injury Severity Score was comparable between groups.No significant difference was found in intensive care unit length of stay and need for tracheostomy. Regarding long-term complications, with a median follow-up time of 15 y, CRIC patients had more upper airway impairment, with most suffering from hoarseness alone. One patient in the CRIC group suffered from esophageal stricture.
CONCLUSIONS: This retrospective comparative analysis did not reveal significant short or long-term sequelae among military personnel 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. The findings of this study could provide valuable insights into managing difficult airway in trauma care and inform clinical decision-making in emergency settings.
METHODS: Data on patients undergoing either CRIC or ETI in the prehospital setting between 1997 and 2021 were extracted from the Israel Defense Forces 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% versus 65%, P = 0.02). Patients who underwent CRIC more frequently exhibited oxygen saturations below 90% (52% versus 29%, P = 0.002). Injury Severity Score was comparable between groups.No significant difference was found in intensive care unit length of stay and need for tracheostomy. Regarding long-term complications, with a median follow-up time of 15 y, CRIC patients had more upper airway impairment, with most suffering from hoarseness alone. One patient in the CRIC group suffered from esophageal stricture.
CONCLUSIONS: This retrospective comparative analysis did not reveal significant short or long-term sequelae among military personnel 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. The findings of this study could provide valuable insights into managing difficult airway in trauma care and inform clinical decision-making in emergency settings.
摘要：
背景：急诊气道管理在创伤护理中至关重要。甲状腺镜切开术（CRIC）是一种通常用于气管插管失败（ETI）或困难气道病例的抢救程序。然而,需要更多关于与CRIC相关的短期和长期并发症的数据.这项研究旨在评估以色列国防军在过去20年中与CRIC的经验，并比较院前CRIC和ETI的短期和长期后遗症。
方法：从以色列国防军创伤登记中提取了1997年至2021年在院前环境中接受CRIC或ETI患者的数据。然后将患者数据与以色列国家创伤登记处交叉引用，记录医院护理，和以色列国防部康复部门登记处，包含军事人员的长期残疾档案。
结果：在122例初次住院的短期随访患者中，81%接受了院前ETI，而19%的人参加了审评委。审评委患者中军事相关伤害和爆炸伤害的患病率较高(96%对65%，P=0.02)。接受审评委更频繁的患者氧饱和度低于90%(52%对29%,P=0.002)。损伤严重程度评分在组间具有可比性。重症监护病房的住院时间和气管造口术的需要没有显着差异。关于长期并发症，中位随访时间为15年，CRIC患者有更多的上呼吸道损伤，只有大多数人患有声音嘶哑。CRIC组中的一名患者患有食管狭窄。
结论：这项回顾性比较分析未发现接受院前评审的军事人员有明显的短期或长期后遗症。长期随访未显示严重的呼吸性损伤，因此表明这种技术是安全的。除了此程序的高成功率外，我们建议审评委留在创伤护理提供者的医疗设备中。这项研究的结果可以为在创伤护理中管理困难的气道提供有价值的见解，并为紧急情况下的临床决策提供信息。
方法：从以色列国防军创伤登记中提取了1997年至2021年在院前环境中接受CRIC或ETI患者的数据。然后将患者数据与以色列国家创伤登记处交叉引用，记录医院护理，和以色列国防部康复部门登记处，包含军事人员的长期残疾档案。
结果：在122例初次住院的短期随访患者中，81%接受了院前ETI，而19%的人参加了审评委。审评委患者中军事相关伤害和爆炸伤害的患病率较高(96%对65%，P=0.02)。接受审评委更频繁的患者氧饱和度低于90%(52%对29%,P=0.002)。损伤严重程度评分在组间具有可比性。重症监护病房的住院时间和气管造口术的需要没有显着差异。关于长期并发症，中位随访时间为15年，CRIC患者有更多的上呼吸道损伤，只有大多数人患有声音嘶哑。CRIC组中的一名患者患有食管狭窄。
结论：这项回顾性比较分析未发现接受院前评审的军事人员有明显的短期或长期后遗症。长期随访未显示严重的呼吸性损伤，因此表明这种技术是安全的。除了此程序的高成功率外，我们建议审评委留在创伤护理提供者的医疗设备中。这项研究的结果可以为在创伤护理中管理困难的气道提供有价值的见解，并为紧急情况下的临床决策提供信息。
