Introduction: Emergency cricothyroidotomy (EC) is a rare but critical intervention in out-of-hospital cardiac arrest (OHCA) when conventional airway management fails. Given the infrequency of EC use in OHCA, systematic knowledge on EC remains limited. Methods: This study was a registry-based follow-up analysis performed to assess the epidemiology of EC in OHCA cases, with a focus on prevalence, success rate, indications, and survival outcomes. The study identified EC cases within the Danish Cardiac Arrest Registry from 2016 to 2022. Cases were retrieved by systematically searching prehospital medical records in the registry, using a pre-specified list of characteristic keywords derived from previously documented EC cases. Finally, the identified cases were manually validated. Results: Out of 36,040 OHCA cases between 2016 and 2022, the search identified 36 cases with EC, yielding a prevalence of approximately 1 in 1,000 cases of OHCA. Cases had a median age of 56 years (IQR 50-70) and were predominantly males (72%). The EC success rate was 89%, with 82% of cases involving unsuccessful intubation attempts prior to attempting EC. Key indications for EC included facial trauma (27%), aspiration-induced airway obstruction (27%), edema/swelling (9%), hypothermia-related rigidity (9%), foreign body airway obstruction (9%), and anatomical challenges due to obesity (6%). Most cases (69%) resulted in death before hospital arrival, 23% had ongoing CPR upon arrival, while 9% achieved successful resuscitation. Conclusion: These findings highlight both the rarity but also the clinical feasibility of EC in prehospital settings. While EC is rarely performed, the high success rate supports its use as a viable last-resort intervention when conventional airway management fails. Additionally, the findings emphasize specific scenarios, such as facial trauma and aspiration-induced airway obstruction, as settings where EC is most likely to be necessary.
Holgersen et al. (Sun,) studied this question.