Authors: Modi R, Shapiro Y, Raizada S, et al.
Cureus 17(9): e92157. doi:10.7759/cureus.92157
This retrospective study examined 32 cases of emergent cricothyrotomy performed at a level 1 trauma center between 2014 and 2025. The goal was to identify pre-morbid conditions and airway findings that predispose patients to failed intubation and necessitate surgical airway access.
The majority of patients were middle-aged men with a mean BMI of 28.9 kg/m². Chronic lung disease was common, with COPD present in 43.8% and asthma in 25%. Nearly one-third had head and neck cancer, and many had prior radiation, surgery, or tracheostomy. Presenting issues most often included angioedema (18.8%), obstructive tumors (18.8%), trauma (12.5%), and acute respiratory failure (12.5%).
Airway edema (59.4%) and blood obscuring the airway (21.9%) were the leading causes of failed intubation. Cricothyrotomy successfully re-established ventilation in all cases, most often performed surgically in the emergency department. Complications included infection (9.4%) and cartilage fractures (6.3%). In-hospital mortality was 21.9%.
The study highlights that distorted airway anatomy from malignancy, radiation, or surgery, along with severe edema, are key predictors of intubation failure. Unlike prior reports, obesity was not a major factor in this cohort. The authors suggest early recognition of these risk factors, incorporation into risk scoring systems, and earlier mobilization of experienced providers could improve patient safety and reduce delays in transitioning to surgical airway management.
What You Should Know
• Patients with COPD, asthma, or head and neck cancer are at higher risk of failed intubation.
• Airway edema was the most common cause of intubation failure, followed by bleeding and distorted anatomy.
• Cricothyrotomy was successful in all cases, but complications and mortality remain significant.
• Early recognition of high-risk patients may improve airway planning and reduce the need for emergent cricothyrotomy.
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