Emergency Front of Neck Access

(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)