(Part One of an evidence review by Jamie Todd)
Starting with the skill in the UK national paramedic guidelines (AACE, 2016) all baseline UK HCPC paramedics as far as I am aware in the event of a can’t ventilate situation are guided to perform the skill of needle cricothyrotomy. This skill usually utilises various pieces of non-purposed clinical equipment that often have to be scavenged from various bags in the ambulance and in my experience as an airway educator there is a general lack of faith in its ability to do anything other than a short period of possible enhanced oxygenation without ventilation.
Certainly, its reported procedural success rate in a meta-analysis of approximately 65% (Crewdson & Lockey, 2013) is of concern especially where other studies see success rates around 37% and a review of USA morbidity cases showed an 89% complication rate with no positive patient outcomes. Various publication define it as a sub-optimal procedure (Resuscitation Council (UK), 2018) so its inclusion as a guided skill is somewhat puzzling to those with an evidence-based medicine approach.
There is some support for this procedure from our colleagues in Anaesthetics where it may be used not only as a rescue technique but also for some specific elective surgical procedures, but their experience is generally of using larger custom-made catheters and specific jet insufflators or ventilators so this is not the same circumstances as seen in the emergency situations in Pre-Hospital Care and so we see very different rates of failures and complications. (Griesdale, 2016)
