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The following is a summary of “Prehospital Cricothyrotomy: A Narrative Review of Technical, Educational, and Operational Considerations for Procedure Optimization,” published in the March 2025 issue of Journal of Emergency Medicine by Lacy et al. 

Prehospital cricothyrotomy a high acuity but infrequently performed airway procedure, requiring proficiency despite limited training and reported clinician discomfort.  

Researchers conducted a retrospective study to evaluate evidence on cricothyrotomy performance and proposed technical, educational, and operational strategies to enhance success and reduce complications in prehospital settings.  

They formed an author group with expertise in prehospital care, emergency medicine, and procedures, including diverse geographic and experiential perspectives. The group identified key areas for prehospital cricothyrotomy and, through consensus, prioritized technical, educational, and operational aspects. Members executed independent literature reviews within the expertise, focusing on emergency medicine, prehospital care, education, and simulation studies, limited to English-language publications. The primary author compiled the manuscript, which was reviewed and approved by the group.  

The results showed that technical strategies in prehospital cricothyrotomy reduced airway misplacement, mainstem intubation, and hemorrhage. Educational approaches emphasized a single technique, structured curricula, spaced repetition using simulation or mental practice, and intentional training on procedure timing. The National Association of Emergency Medical Services (EMS) Physicians recommended the surgical technique as the preferred method. Operational improvements included checklists, preassembled kits, and comprehensive quality assurance following cricothyrotomy.  

Investigators concluded that by focusing on technical, educational, and operational considerations relating to prehospital cricothyrotomy, prehospital clinicians could optimize the chance for procedural success. 

Source: jem-journal.com/article/S0736-4679(24)00284-1/fulltext