Page 27 - JSOM Spring 2023

increase from 2012–2013 for prehospital intubation (Tables SUPPLEMENTAL TABLE 1 Summary of Tactical Combat Casualty
2, 3). In both unadjusted and adjusted regression models, we Care Guideline Changes Throughout Study Period
identified no year-to-year differences in survival after prehos- 2007 1. Airway management
pital cricothyrotomy nor SGA placement (Table 4). • Chin lift or jaw thrust
• Unconscious casualty without airway obstruction:
nasopharyngeal airway
TABLE 1 Description of Casualties Included in the Analysis • Unconscious casualty with airway obstruction:
Cricothyrotomy Intubation Supraglottic cricothyroidotomy
N = 251 N = 1,149 N = 35 • Cervical spine immobilization is not necessary for
casualties with penetrating head or neck trauma
Demographics 2014 a. Unconscious casualty without airway obstruction:
Age 25 (21–30) 24 (21–30) 28 (22–33) • Chin lift or jaw thrust maneuver
Male 98% (246) 98% (1,127) 97% (34) • Nasopharyngeal airway
• Place casualty in the recovery position
Affiliation b. Casualty with airway obstruction or impending airway
US Military 27% (68) 23% (270) 25% (9) obstruction:
NATO Military 5% (15) 9% (112) 5% (2) • Chin lift or jaw thrust maneuver
Non-NATO Military 35% (88) 37% (431) 37% (13) • Nasopharyngeal airway
• Allow casualty to assume any position that best
Humanitarian 31% (80) 29% (336) 31% (11) protects the airway, to include sitting up
Mechanism of Injury • Place unconscious casualty in the recovery position
Explosive 54% (138) 57% (663) 45% (16) • If previous measures unsuccessful: Surgical
cricothyroidotomy (with lidocaine if conscious)
Firearm 33% (83) 30% (349) 48% (17) 2016 a. Unconscious casualty without airway obstruction:
Motor vehicle 9% (23) 7% (88) 5% (2) • Chin lift or jaw thrust maneuver
Other 2% (7) 4% (49) 0% (0) • Nasopharyngeal airway
• Place casualty in the recovery position
Military Operation b. Casualty with airway obstruction or impending airway
OEF 67% (170) 75% (863) 74% (26) obstruction:
OFS 12% (32) 1% (19) 14% (5) • Chin lift or jaw thrust maneuver
• Nasopharyngeal airway
OIF 14% (37) 21% (240) 2% (1) • Allow a conscious casualty to assume any position
OIR 3% (10) 1% (16) 8% (3) that best protects the airway, to include sitting up.
• Place unconscious casualty in the recovery position.
OND 1% (2) 1% (11) 0% (0) c. If the previous measures are unsuccessful, perform a
Injury Severity Score surgical cricothyroidotomy using one of the following:
Composite 24 (14–30) 18 (10–26) 25 (16–33) • Cric-Key technique (preferred option)
Serious injuries by body region • Bougie-aided open surgical technique using a flanged
and cuffed airway cannula of less than 10mm outer
Head/neck 61% (154) 37% (435) 42% (15) diameter, 6–7mm internal diameter, and 5–8cm of
Facial 3% (10) 1% (9) 2% (1) intratracheal length
Thorax 23% (58) 19% (225) 42% (15) • Standard open surgical technique using a flanged
and cuffed airway cannula of less than 10mm outer
Abdomen 9% (24) 12% (141) 22% (8) diameter, 6–7mm internal diameter, and 5–8cm of
Extremities 25% (63) 38% (438) 22% (8) intra-tracheal length (least desirable option)
Skin 7% (20) 5% (59) 2% (1) • Use lidocaine if the casualty is conscious
August a. Conscious casualty with no airway problem identified:
Outcome 2017 • No airway intervention required
Ventilator days 2 (1–5) 2 (1–4) 1 (1–1) b. Unconscious casualty without airway obstruction:
ICU days 2 (0–6) 2 (1–6) 1 (0–3) • Place casualty in the recovery position
Hospital days 2 (1–8) 3 (1–7) 4.5 (1–8) • Chin lift or jaw thrust maneuver or nasopharyngeal
airway or extraglottic airway
Survival 60% (152) 76% (883) 54% (19) c. Casualty with airway obstruction or impending airway

NATO = North Atlantic Treaty Organization, OEF = Operation En- obstruction:
during Freedom, OFS = Operation Freedom’s Sentinel, OIF = Opera- • Allow a conscious casualty to assume any position
tion Iraqi Freedom, OIR = Operation Inherent Resolve, OND = Op- that best protects the airway, to include sitting up
eration New Dawn • Use a chin lift or jaw thrust maneuver
• Use suction if available and appropriate
FIGURE 1 Volume of procedures during the study period. • Nasopharyngeal airway or
• Extraglottic airway (if the casualty is unconscious)
• Place an unconscious casualty in the recovery
position.
d. If the previous measures are unsuccessful, perform a
surgical cricothyroidotomy using one of the following:
• Cric-Key technique (preferred option)
• Bougie-aided open surgical technique using a flanged
and cuffed airway
• cannula of less than 10mm outer diameter, 6–7mm
internal diameter, and 5–8cm of intratracheal length
• Standard open surgical technique using a flanged
and cuffed airway cannula of less than 10mm outer
diameter, 6–7mm internal diameter, and 5–8cm of
intra-tracheal length (least desirable option)
• Use lidocaine if the casualty is conscious
(continues)

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