Cricothyroidotomy in out-of-hospital cardiac arrest: An observational study

Aim

To describe the incidence, characteristics, success rates, and outcomes of out-of-hospital cardiac arrest (OHCA) patients receiving cricothyroidotomy.

Methods

Over an 18-year period, we retrospectively analysed patient care records and cardiac arrest registry data for cricothyroidotomy cases. Multivariable logistic regression analysis was used to examine associations between study characteristics and cricothyroidotomy success.

Results

We identified 80 cricothyroidotomies, 56 of which occurred in OHCA. The incidence of cricothyroidotomy in OHCA was 1.1 per 1,000 attempted resuscitations and increased over the study period (incidence rate ratio [IRR] = 1.13, 95 % confidence interval [CI]: 1.02–1.25, p = 0.023). The overall success rate was 68.8 % (n = 55/80), with lower success in cardiac arrest (n = 33/56, 58.9 %) than non-cardiac arrest patients (n = 22/24, 91.7 %). In OHCA, success rates were higher for surgical compared to needle techniques (88.2 % vs. 54.6 %, p = 0.003). Cardiac arrest (odds ratio [OR] 0.09, 95 % CI 0.16–0.51) and needle techniques (OR 0.11, 95 % CI 0.02–0.56) were independently associated with lower odds of procedural success, while male sex (OR 10.06, 95 % CI 2.00–50.62) was associated with higher odds. Return of spontaneous circulation occurred in 44.6 % (n = 22/56), with 35.7 % (n = 20/56) surviving to hospital and 7.1 % (n = 4/56) surviving to hospital discharge. Procedural complications included cardiac arrest (n = 6/56, 10.7 %), minor bleeding (n = 5/56, 8.9 %), surgical emphysema (n = 3/56, 5.4 %), and major bleeding (n = 2/56, 3.6 %).

Conclusion

We found cricothyroidotomy in OHCA to be associated with low rates of procedural success and high mortality rates. Further studies are required to assess the role and potential benefits of cricothyroidotomy in cardiac arrest.