Page 23 - Journal of Special Operations Medicine - Fall 2015

Emergency Cricothyroidotomy
WHEN TIME COUNTS in Tactical Combat Casualty Care

RELY ON TELEFLEX. T.A.L.O.N. 7-SITE TACTICAL ADVANTAGE
™
NEEDLE SET
When faced with difficult vascular access, our Robert Mabry, MD; Alan Frankfurt, MD; Chetan Kharod, MD; Frank Butler, MD
Military-use solutions provide pre-hospital NSN: 6515-01-626-6395
providers the opportunity to impact lives.

The EZ-IO T.A.L.O.N. Needle Set and the T.A.L.O.N. ™ Proximate Cause for This Proposed Change
™
®
Needle Set
Arrow EZ-IO Intraosseous Vascular Access The performance of a surgical airway is an infrequently Few of these patients survive with a good neurological
®
®
System offer users an intraosseous (IO) vascular EZ-Connect ® performed, but occasionally lifesaving, procedure on the outcome. 1,4,6
battlefield. Since a combatant who sustains a wound that
Extension Set
access solution for rapid medication and fluid Sternal damages the upper airway structures is often in extremis Complications are frequent and include failed at-
Locator
delivery during casualty resuscitation. shortly after the wound is sustained, this is a procedure tempts, bleeding, injury to thyroid vessels, incorrect
that must be performed by the individual who is caring anatomic placement, main-stem bronchial intubation,
for the casualty at the point of injury: the combat medic. misplacement into subcutaneous tissues, esophageal
There are a variety of techniques and equipment avail- injury or intubation, and damage to associated airway
able to perform this technique. In the past, the Commit- structures. 3,6–11 The infrequency with which SC is per-
tee on Tactical Combat Casualty Care (CoTCCC) has formed, the critical nature of the patients who require
• LIFE-SAVING: Delivers fluids and medications not recommended a specific equipment item for the per- SC, and the risk for significant complications combine
rapidly for casualty resuscitation
formance of surgical airways. A recent study with Army to make SC a high-risk, anxiety-provoking, and often
• SIMPLE: Designed for any level responder 68-Whiskey medics trained to the Emergency Medical difficult to perform procedure. Success rates are variable
Technician–Basic (EMT-B) level found that the use of among providers, ranging from 62% to 100%. 7
a new equipment item, the CricKey, resulted in surgi-
cal airways being performed on fresh human cadavers Performing SC is even more difficult in the tactical
by medics faster than with the standard open surgi- setting, where there are often few medical providers,
EZ-IO INTRAOSSEOUS VASCULAR ACCESS cal technique, and with a 100% first-pass success rate multiple casualties, ongoing combat nearby, and poor
®
SYSTEM FOR MILITARY USE compared with a 70% first-pass success rate using the lighting. The military tactical environment is further de-
EZ-IO ® standard technique. At this time, the CricKey has the fined in Table 1. Combat medics performing SC in Iraq
Power Driver best supporting evidence for enabling successful perfor- and Afghanistan failed to cannulate the airway in 33%
mance of surgical airways by combat medical personnel of SC attempts. Historically, 1% to 2% of battlefield
6
and is proposed as the device of choice for TCCC. deaths and 8% to 15% of potentially preventable deaths
EZ-Stabilizer ® are caused by traumatic obstruction of the airway, usu-
Dressing ally from penetrating maxillofacial or neck trauma. 12,13
Background
Surgical cricothyroidotomy (SC) is a critical emergency Although numerous SC techniques have been described,
PROXIMAL HUMERUS
airway management technique. This potentially lifesav- there is no consensus in the literature as to which tech-
5
STERNUM 45 mm ing procedure is rarely required and rarely performed. nique or device is superior or preferred. Most studies of
1–5
25 mm EZ-Connect ® While SC rates are nearly double in the military setting SC techniques are performed by physicians already famil-
PROXIMAL TIBIA EZ-IO ® Extension Set compared with the civilian setting, they still occur in less iar with the anatomy of the airway and a variety of airway
Needle Sets
DISTAL TIBIA than 1% of all trauma admissions. 6 management techniques. Yet in the military prehospital
setting, the operator most likely to perform SC in a timely
SC is the final pathway in the “can’t intubate, can’t and lifesaving manner will be a combat medic, Corpsman,
ventilate” situation in all difficult airway algorithms. or Pararescueman. These providers will typically have
It is usually deferred until all other options for airway little airway management experience outside the training
TELEFLEX.COM/MILITARY management have failed. In many instances, the patient laboratory. Few if any will have managed the airway of a
is critically ill and in extremis. A high complication live patient before having to perform SC on a fellow unit
2–4
rate, especially in the prehospital setting, is also associ- member, who is likely a personal acquaintance.
Product of the U.S.A. Potential complications may include local or systemic infection, hematoma, extravasations or other complications associated with percutaneous insertion of sterile devices. ated with SC. 1,6,7 Overall survival rates for those who
Teleflex, Arrow, EZ-Connect, EZ-IO, EZ-Stabilier and T.A.L.O.N. are trademarks or registered trademarks of Teleflex Incorporated or its affiliates. undergo SC are low and likely reflect the fact that 30% SC techniques for the tactical environment must take
© 2015 Teleflex Incorporated. All rights reserved. MC-000955 Rev 1
to 80% are in cardiac arrest prior to the procedure. into account the injury patterns encountered, the level of
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