• Joost Peters, Loes Bruijstens, Jeroen van der Ploeg, Edward Tan, Nico Hoogerwerf, and Michael Edwards.
• Department of Trauma Surgery, Radboud University Medical Center, Nijmegen, The Netherlands; Helicopter Emergency Medical Service, Radboud University Medical Center, Nijmegen, The Netherlands. Electronic address: Joost.Peters@radboudumc.nl.
• Injury. 2015 May 1;46(5):787-90.

BackgroundAirway management is essential in critically ill or injured patients. In a "can't intubate, can't oxygenate" scenario, an emergency surgical airway (ESA), similar to a cricothyroidotomy, is the final step in airway management. This procedure is infrequently performed in the prehospital or clinical setting. The incidence of ESA may differ between physician- and non-physician-staffed emergency medical services (EMS). We examined the indications and results of ESA procedures among our physician-staffed EMS compared with non-physician-staffed services.MethodsData for all forms of airway management were obtained from our EMS providers and analyzed and compared with data from non-physician-staffed EMS found in the literature.ResultsAmong 1871 patients requiring a secured airway, the incidence of a surgical airway was 1.6% (n=30). Fourteen patients received a primary ESA. In 16 patients, a secondary ESA was required after failed endotracheal intubation. The total prehospital ESA tracheal access success rate was 96.7%.ConclusionThe incidence of ESA in our patient population was low compared with those reported in the literature from non-physician-staffed EMS. Advanced intubation skills might be a contributing factor, thus reducing the number of ESAs required.Copyright © 2014 Elsevier Ltd. All rights reserved.

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