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type was not reported. Hardy et al. studied 1,267 US Army TABLE 2 Cricothyroidotomy Results Summary
medical evacuation patients from Operation Enduring Free- No. interventions
13
dom from 2011 to 2014. Nearly half of patients (617) re- Study Provider type (% of total) Success
quired some form of airway intervention, although only four Adams et al. Total 17 (100%) 76.4%
were managed with endotracheal intubation (one performed 2008 Unknown 6 (35.3%)
by a medic and three performed by paramedics). Success rates
and number of attempts was not reported. Gerhardt et al. ex- Medic 4 (23.5%)
amined 318 casualties from a forward operating base in cen- Physician 4 (23.5%)
14
tral Iraq from 2004 to 2005. Ten intubations were performed PA 2 (11.8%)
(3.1%), all by a physician or PA. Maddry and Bebarta studied Nurse anesthetist 1 (5.9%)
prehospital airway interventions of 1,022 patients transported Barnard et al. Total 34 (100%) 82.40%
15
to US military facilities in Afghanistan from 2011 to 2014. 2014 Helicopter medic 18 (52.9%)
Twenty-two prehospital intubations were conducted (2.2%). Unknown 10 (29.4%)
Finally, Murad et al. studied 2,788 Iraqi trauma patients from Ground Medic 6 (17.6%)
1997 to 2006, all treated by local national paramedics. The Blackburn et al. Total 16 (100%) —
16
injuries were from landmines, war injuries and traffic colli- 2018 Physician 8 (50%)
sions. Nineteen intubations were performed (0.7%).
Medic 8 (50%)
Gerhardt et al. Total 4 (100%) —
Cricothyroidotomy 2011 Physician/PA 3 (75%)
Seventeen studies reported on prehospital combat cricothyroi- Medic 1 (25%)
dotomy – twelve from the war in Afghanistan, six from the war Haldane 2010 Total 13 —
in Iraq, one from the IDF, and one from a local national Iraqi Hardy et al. Total 28 (100%) —
experience. Nine reported whether or not the attempts at crico- 2018 Medic 15 (54%)
thyroidotomy were successful (Table 2). It should be noted that Paramedic 10 (36%)
patient selection influences success rates and is influenced by Unknown 3 (11%)
available airway management strategies and personnel train- Katzenell et al. Total 46 93.5%
ing. Some medics may be trained to escalate to cricothyroidot- 2013
omy after a failed nasopharyngeal airway attempt. 18 Kyle et al. Total 86 91.9%
2016 Combat Medic 80 (93%)
Adams et al. found that of 293 prehospital advanced airways or Physician
and 17 cricothyroidotomies were performed (5.8%). Four were MERT 6 (7%)
performed by combat medics (23.5%), two by PAs (11.8%), Lairet et al. Total 15 86.7%
one by a nurse anesthetist (5.9%), four by physicians (23.5%), 2012
and six by unspecified practitioners (35.3%). There were four Mabry and Total 72 (100%) 68.1%
7
airway complications identified (23.5%): one left mainstem Frankfurt 2012 Medic 45 (62.5%) 62.2%
intubation performed by a medic; one aborted attempt with
placement of an esophageal-tracheal airway by a physician; Physician/PA 27 (37.5%) 77.7%
and two failed cricothyroidotomies were performed by prac- Mabry et al. Medic 3 66.7%
titioners whose training was not described, with one placed in 2011
the hypopharynx and one in the subcutaneous tissues. Maddry and Total 19 —
Bebarta 2015
Murad et al. Total 1 —
Barnard et al. studied prehospital interventions performed for 2012
1,927 patients presenting to six combat hospitals in Iraq and Pugh et al. Total 14 85.7%
19
Afghanistan, from 2009 to 2013. Thirty four patients had 2015
attempted cricothyroidotomy (1.8%), with 28 being successful Schauer, April, Medic 4 75.0%
(82%). Six complications occurred: one left mainstem bron- Cunningham
chus placement, one in the subcutaneous tissues, and four un- et al. 2017
successful with no reason recorded. Five cricothyroidotomies Schauer, April, Total 1 —
were preceded by attempted endotracheal intubation. For 24 Simon, et al.
patients, the provider type was recorded: six were by combat 2017
medics, and 18 by helicopter medic. Tobin et al. Total 13 —
2015
Katzenell et al. reported on 46 cricothyroidotomies conducted *PA = physician assistant.
1
by the IDF; they had a success rate of 93% (43). They reported
that the majority of the surgical airways were performed by Lairet et al. found that of 1,003 patients with lifesaving in-
physicians or highly trained military paramedics. terventions, 15 surgical cricothyroidotomies were performed
10
(1.5%), with 13 being successful (87%). The treating physi-
Kyle et al. studied the United Kingdom Joint Theater Trauma cians felt that two of the patients who did not have a cricothy-
Registry and the Central Health Records Library for Afghan- roidotomy should have had one attempted in the field. It was
istan casualties from 2006 to 2014. Eighty-six cricothyroi- not specified who provided the intervention.
20
dotomies were attempted with a 92% success rate (79). Six
were performed by MERT, and 80 were performed by either a Mabry and Frankfurt studied the American Joint Theater
medic or a general duty medical officer. Trauma Registry (now called Department of Defense Trauma

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