Outcomes and Long Term Follow-up after Emergent Cricothyroidotomy: Is Routine Conversion to Tracheostomy Necessary?

Abstract

The purpose of this study is to identify factors associated with survival after cricothyroidotomy (CRIC), and to ascertain long-term outcomes in patients simply decannulated after CRIC versus those revised to tracheostomy. All CRICs between October 1, 1995 and June 20, 2010 were reviewed. Patients were contacted by phone, visited at their last known address, or queried in the Center for Disease Control's National Death Index. DECAN were those CRICs decannulated without revision. TRACH were those revised to a tracheostomy at any point. Ninety-five CRIC patients were identified. In 94 per cent of survivors of initial admission, a Glasgow Coma Score (GCS) of 15 was noted at disposition. Cardiopulmonary resuscitation before or during CRIC performance was strongly associated with all-cause death during index admission, and increasing head Abbreviated Injury Score was associated with lower odds of a neurologically intact survival. Of survivors, 82 per cent of DECAN and 57 per cent of TRACH patients were followed-up with at medians of 48 (interquartile range 19-57) and 53 (20-119) months, respectively. DECAN occurred at a median of 4 days (2-7) whereas TRACH revision occurred at a median of 2 days (1-7). Endoscopy was performed on 36 per cent of DECAN patients and 22 per cent of TRACH patients. Two DECAN patients with acute subglottic edema/stenosis decannulated successfully on days 9 and 15 postinjury and had no problems at 54 and 91 months postinjury. At follow-up, no patient in either group had suffered a clinically evident airway complication. The need for cardiopulmonary resuscitation before or during CRIC portends poorly for neurologically intact survival. Simple decannulation is appropriate for CRIC patients when their need for airway protection has resolved.