Page 29 - Journal of Special Operations Medicine - Fall 2015

– Chin lift or jaw thrust maneuver than 10mm outer diameter, 6mm to 7mm in-
– Nasopharyngeal airway ternal diameter, and 5cm to 8cm of intratra-
– Place casualty in the recovery position cheal length
b. Casualty with airway obstruction or impending • Standard open surgical technique using a
airway obstruction: flanged and cuffed airway cannula of less
– Chin lift or jaw thrust maneuver than 10mm outer diameter, 6mm to 7mm in-
– Nasopharyngeal airway ternal diameter, and 5cm to 8cm of intratra-
– Allow casualty to assume any position that best cheal length (least desirable option)
protects the airway, to include sitting up. Use lidocaine if the casualty is conscious.
– Place unconscious casualty in the recovery c. Spinal immobilization is not necessary for casual-
position. ties with penetrating trauma.
c. If the previous measures are unsuccessful, per-
form a surgical cricothyroidotomy using one of Vote
the following:
• CricKey technique (preferred option) This change was approved by the required two-thirds or
greater majority of the voting members of the Commit-
• Bougie-aided open surgical technique using a tee on Tactical Combat Casualty Care.
flanged and cuffed airway cannula of less than
10mm outer diameter, 6mm to 7mm internal di- Level of evidence: (American Heart Association/Ameri-
ameter, and 5cm to 8cm of intratracheal length can College of Cardiology )
40
• Standard open surgical technique using a flanged The levels of evidence used by the American College of
and cuffed airway cannula of less than 10mm Cardiology and the American Heart Association were
outer diameter, 6mm to 7mm internal diameter, outlined by Tricoci et al. in 2009. 40
and 5cm to 8cm of intratracheal length (least de-
sirable option) – Level A: Evidence from multiple randomized
Use lidocaine if the casualty is conscious. trials or meta-analyses.
– Level B: Evidence from a single randomized
Tactical Evacuation Care trial or nonrandomized studies.
– Level C: Expert opinion, case studies, or stan-
The term “Tactical Evacuation” includes both Casu- dards of care.
alty Evacuation (CASEVAC) and Medical Evacuation Using the above taxonomy, the level of evidence for
(MEDEVAC) as defined in Joint Publication 4-02.
the CricKey as the preferred surgical airway option in
1. Airway Management TCCC is Level B. 38,40
a. Unconscious casualty without airway obstruction:
– Chin lift or jaw thrust maneuver Recommendations for
– Nasopharyngeal airway Further Research and Development
– Place casualty in the recovery position 1. Improved Surgical Airway Training Methods. Per-
b. Casualty with airway obstruction or impending formance of a surgical airway is probably the most
airway obstruction:
– Chin lift or jaw thrust maneuver technically difficult lifesaving intervention that
Combat medics must master. The use of all possible
– Nasopharyngeal airway methods, potentially including live-tissue training,
– Allow casualty to assume any position that best advanced and antomically precise airway simulators,
protects the airway, to include sitting up.
– Place unconscious casualty in the recovery and techniques that ensure mastery of airway anat-
omy knowledge, should be evaluated to improve the
position.
ability of medics to perform this intervention.
– If the previous measures are unsuccessful, assess 2. Optimized Airway Devices for Trauma. New and im-
the tactical and clinical situations, the equip- proved techniques and technologies for securing the
ment at hand, and the skills and experience of injured airway should comtinue to be pursued.
the person providing care, and then select one 3. Monitoring of airway status, prehospital interven-
of the following airway interventions:
– Supraglottic airway, or tions, and outcomes in Combat casualties should be
accomplished using information contained in the De-
– Endotracheal intubation or partment of Defense Trauma Registry.
– Perform a surgical cricothyroidotomy using
one of the following:
• CricKey technique (preferred option) Acknowledgments
• Bougie-aided open surgical technique using Dr Richard Levitan designed the CK and provided the
a flanged and cuffed airway cannula of less prototypes used in this study. Airway Cam Technologies

Emergency Cricothyroidotomy in TCCC 17