A survey of surgical airway experiences and equipment among immediate care doctors

Background: There is a variety of approaches to obtaining a surgical airway, but little literature on techniques other than surgical cricothyroidotomy and the placement of a cuffed tube. Methods: An e-mail and postal survey of the memberships of the British Association for Immediate Care (BASICS) and BASICS (Scotland) was performed to ascertain the equipment carried for a surgical airway and obtain summarised case reports of the surgical airways performed. Results: The response rate was 359 of 942 surveys sent (38%). Most doctors carry equipment to perform a surgical airway. A total of 93 prehospital surgical airways was reported as summarised cases. A needle cricothyroidotomy was initially obtained in 17 cases (18%) but was changed to other types in all but six cases. Of these six patients, two survived to hospital. A small uncuffed tube was initially placed in 29 patients (31%) and remained in 23 cases; 22 survived to hospital. A surgical cricothyroidotomy and placement of a cuffed tube was the initial airway obtained in 51 cases and the final airway obtained in 64 (69%) patients; 34 survived to reach hospital. Some spontaneous ventilation remained in 56 (60%) patients. Conclusions: This paper reports the successful prehospital use of small uncuffed tubes in both breathing and apnoeic patients. The survival rate to hospital following a prehospital surgical airway is reasonable. There is a high incidence of spontaneous ventilation in this patient cohort. There were a number of limitations with this study, but the subject is worthy of further research.