[Cricothyrotomy for airways management: current data and interest for combat casualty care]

Abstract

Objectives: To detail current data in cricothyrotomy and imperatives of airway management in combat casualty care.

Methods: Review of the literature in Medline database over the past 40 years.

Results: Modern armed conflicts, including guerrilla and terrorism, have changed the approach of tactical combat casualty care. The first medical support must be as close as possible to the battlefield, reducing casualties thanks to a quick intervention. Because of a lack of physicians on the battlefield, the first operator is often a paramedical staff trained to simple lifesaving procedures. The orotracheal intubation remains the gold standard for airways management, but often impossible because of the environmental factors of the battlefield. Therefore, cricothyrotomy may become an interesting choice in this case and not only an alternative for orotracheal intubation like in civilian practice. It provides an easy and safe underglottis airways access by a laryngotomy between the cricoid and the thyroid cartilages. Performed by paramedical staff, it is a strictly protocolized delegated medical prescription.

Conclusion: This review of literature and the analysis of commercial kits prompt us to suggest safe methods that can be performed on battlefield. Surgical methods and MiniTrach II kit (Portex) seem to be particularly suitable for battlefield situations. An airways management algorithm for combat casualty care is also proposed.