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Registry) from 2007 to 2009 to identify all patients who re- TABLE 3 Supraglottic Airway Results Summary
ceived prehospital cricothyroidotomy in Afghanistan and No. interventions
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Iraq. Seventy-two cricothyroidotomies were performed with Study Provider type (% of total) Success
49 being successful (68%); 45 were performed by medics, and Adams et al. Total 23 91.3%
27 were performed by physicians or PAs. Of the 45 done by 2008 Medic 14 (61%)
medics, 28 were successful (62%). Of the 27 done by physi-
cians/PAs, 21 were successful (77%). Physician 5 (22%)
Unknown 4 (17%)
Mabry et al. reported on 20 patients with prehospital airway Blackburn et al. Total 5 —
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interventions. Three cricothyroidotomies were performed, 2018 Medic 3 (60%)
all by medics, with two being successful (66%). Pugh et al. Physician 1 (20%)
reported on 14 cricothyroidotomies performed in Helmand Unknown 1 (20%)
province Afghanistan; 12 were successful (86%). Practitioner Haldane 2010 Total 2 50.0%
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training was not reported. Schauer et al. examined the Depart- Hardy et al. Total 22 —
ment of Defense Trauma Registry and the Prehospital Trauma 2018 Medic 14 (64%)
Registry from 2013 to 2014 in Afghanistan for cricothyroi- Paramedic 8 (36%)
dotomies performed by medics using commercially available
kits. Four were attempted and three were successful (75%). 23 Mabry et al. Medic 12 91.7%
2011
Pugh et al. 2015 Total 6 50.0%
Blackburn et al. found that of 132 patients that required an
airway management procedure, 16 cricothyroidotomies were Schauer, April, Total 1 —
Simon, et al.
8
performed (12%). On five occasions, cricothyroidotomy was 2017
used as a rescue technique after another airway procedure was Shavit et al. Physician 18 88.9%
attempted. Eight cricothyroidotomies were performed by med- 2017
ics and eight were performed by physicians.
success (50%). Mabry et al. studied 20 patients with prehospi-
Seven studies reported the usage of cricothyroidotomy in the tal airway interventions. Eleven Combitubes were placed and
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combat setting, without reporting success rate. Gerhardt et al. one LMA. All were by medics, and 11 were successful (92%).
studied 318 casualties in Iraq, and four cricothyroidotomies Shavit et al. studied 18 patients who underwent LMA as a
14
were performed (1.3%). One was performed by a medic and rescue intervention after failed intubation, 16 were successful
three were performed by physicians. Haldane et al. studied 530 (89%). These were performed by a flight physician. Pugh et
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patients transported by MERT and 13 cricothyroidotomies al. reported on six supraglottic airways, and three were suc-
9
were performed (2.5%). Hardy et al. studied 617 patients cessful (50%). The training level of the care providers was
22
requiring airway interventions and 28 cricothyroidotomies not reported.
(4.5%) were performed: 15 by medics, 10 by paramedics, and
three by unspecified providers. Maddry and Bebarta studied Three remaining studies reported on the use of supraglottic
1,022 medevac records and 19 cricothyroidotomies were per- airways, but without specifically reporting success rates. Black-
formed (1.8%). Murad et al. studied 2,788 Iraqi trauma pa- burn et al. studied 132 airway procedures; four (3.0%) were
15
tients and one cricothyroidotomy was performed. Schauer et supraglottic airways. Three were performed by medics, and
8
al. studied the Department of Defense Trauma Registry and one by a medical officer. Hardy et al. studied 617 airway inter-
the Prehospital Trauma Registry, for Iraq and Afghanistan for ventions. Twenty-two supraglottic airways were performed
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mass casualty events between 2011 to 2014 and found one cri- (3.6%), 14 by medics, and eight by paramedics. Schauer et al.
cothyroidotomy. Tobin et al. studied critical care transport studied 2017 patients involved in mass casualty events, and
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patients finding 13 cricothyroidotomies were performed. 17 one supraglottic airway was performed. 24
Supraglottic Airways Nasopharyngeal/Oropharyngeal Airways
Eight studies reported on prehospital supraglottic airway: Three studies reported on prehospital combat use of nasal and
five from the war in Afghanistan, four from the war in Iraq, oropharyngeal airways, with one reporting success rate. All
and one from the IDF. Five of these reported on success rates three were from the Afghanistan war (Table 4).
(Table 3).
Lairet et al. studied 1,003 patients, reporting that 27 prehospi-
Adams et al. studied 293 patients with prehospital advanced tal nasopharyngeal (NPA)/oropharyngeal (OPA) airways were
7
airways, and 23 (7.8%) were supraglottic airways. Twenty- placed (2.7% of patients). The receiving physicians believed
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one were successful (91.3%). Fourteen were performed by that 10 additional patients would have benefited from NPA/
medics (60.9%), five by physicians (21.7%), and the remainder OPA in the field, but did not receive the intervention. Two
by unknown practitioners. Of the supraglottic airways, two NPAs were incorrectly placed giving a success rate of 93%.
were laryngeal mask airways (LMA). One LMA was successful
and the other unsuccessful due to dislodgement (50% success Blackburn et al. studied 133 airway procedures, of which 26
rate). The remaining 21 were esophageal-tracheal airways, of NPAs (19.7%) and two OPAs (1.5%) were placed. Eighteen
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which 20 were successful (95%). of the 26 NPAs that were placed were the only airway proce-
dure performed. Of those 18, 50% were performed by med-
Haldane et al. studied 530 patients who required MERT trans- ics, 28% by physicians, and 22% by unknown practitioner.
port. Two supraglottic airways were performed, with one Success rates were not reported. Hardy et al. studied 1,267
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34 | JSOM Volume 23, Edition 1 / Spring 2023