North West Ambulance Service brings surgical cricothyroidotomy to paramedic practice

Consultant Paramedic Steve Bell.

Consultant Paramedic Steve Bell.

The North West Ambulance Service’s advanced and consultant paramedics are performing a procedure previously restricted to the remit of doctors. Surgical cricothyroidotomy was introduced into the scope of practice of NWAS’ advanced and consultant paramedics in 2011 as an emergency airway management intervention for otherwise unmanageable patient airways resulting from traumatic or medical aetiologies.

A recent service evaluation demonstrated a favourable success rate when compared to other professional groups undertaking the procedure and provided valuable insight for the trust’s governance and assurance processes. The service evaluation was completed by Consultant Paramedic Steve Bell and is believed to be the first published British paramedic cohort of peer-reviewed evidence on the technique.

During the period between November 2012 and April 2017 pre-hospital surgical cricothyroidotomy was performed on a total of 36 occasions by NWAS advanced and consultant paramedics. Medical cardiac arrest accounted for 18 (50%) and traumatic cardiac arrest for 12 (33%) of interventions. The remaining six (17%) interventions were performed on patients with cardiac output at the time of the intervention.

The overall success rate for pre-hospital surgical cricothyroidotomy, defined as the provision of adequate ventilation via surgical cricothyroidotomy with confirmation of tube position using end tidal carbon dioxide capnography, was 97% (n = 35). There were no reported complications or adverse incidents as a result of attempts of surgical cricothyroidotomy during the evaluation period.

Mike Jackson, Chief Consultant Paramedic, said, “The innovative work undertaken by our advanced and consultant paramedics in performing surgical cricothyroidotomy demonstrates excellent performance in relation to successful placement of the emergency airway. This success is a credit to skill and dedication of the cohort.”

Following evaluation, the overall finding demonstrates that surgical cricothyroidotomy produces highly favourable success rates when compared with other national and international professional groups undertaking the intervention within the pre-hospital environment. Moving forward, the trust will ensure enhanced governance around the procedure providing both increased assurance as well as enhanced data capture for future review and evaluation.