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The success of battlefield surgical airway insertion in severely injured military patients: a UK perspective
  1. Tony Kyle1,2,
  2. S le Clerc1,3,
  3. A Thomas1,
  4. I Greaves1,3,
  5. V Whittaker4 and
  6. J E Smith1,5
  1. 1Academic Department of Military Emergency Medicine, Royal Centre for Defence Medicine (Research & Academia), Medical Directorate, Birmingham, UK
  2. 2Academic Department of Military Emergency Medicine (North), Institute of Learning Research & Innovation, James Cook University Hospital, Middlesbrough, UK
  3. 3Emergency Department, James Cook University Hospital, Middlesbrough, UK
  4. 4Health and Social Care Institute, Teesside University, Middlesbrough, UK
  5. 5Emergency Department, Derriford Hospital, Plymouth, UK
  1. Correspondence to Tony Kyle, Academic Department of Military Emergency Medicine, Royal Centre for Defence Medicine (Research & Academia), Medical Directorate, Birmingham, B15 2SQ UK; tony.kyle{at}


Background The insertion of a surgical airway in the presence of severe airway compromise is an uncommon occurrence in everyday civilian practice. In conflict, the requirement for insertion of a surgical airway is more common. Recent military operations in Afghanistan resulted in large numbers of severely injured patients, and a significant proportion required definitive airway management through the insertion of a surgical airway.

Objective To examine the procedural success and survival rate to discharge from a military hospital over an 8-year period.

Methods A retrospective database and chart review was conducted, using the UK Joint Theatre Trauma Registry and the Central Health Records Library. Patients who underwent surgical airway insertion by UK medical personnel from 2006 to 2014 were included. Procedural success, demographics, Injury Severity Score, practitioner experience and patient survival data were collected. Descriptive statistics were used for data comparison, and statistical significance was defined as p<0.05.

Results 86 patients met the inclusion criterion and were included in the final analysis. The mean patient age was 25 years, (SD 5), with a median ISS of 62.5 (IQR 42). 79 (92%) of all surgical airways were successfully inserted. 7 (8%) were either inserted incorrectly or failed to perform adequately. 80 (93%) of these procedures were performed either by combat medical technicians or General Duties Medical Officers (GDMOs) at the point of wounding or Role 1. 6 (7%) were performed by the Medical Emergency Response Team. 21 (24%) patients survived to hospital discharge.

Discussion Surgical airways can be successfully performed in the most hostile of environments with high success rates by combat medical technicians and GDMOs. These results compare favourably with US military data published from the same conflict.

  • military
  • multiple trauma
  • surgical airway
  • cricothyroidotomy
  • airway obstruction

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  • Contributors The following individuals have contributed to the article: TK: contributed on all aspects of the article including literature search and review, data collection, data analysis and write up. Is the guarantor for the overall content of the paper. SleC: contributed to writing the initial and subsequent versions of the manuscript. AT: contributed to data collection and writing the manuscript. IG: contributed to writing the manuscript and approved the final version. VW: statistician involved in all elements of statistical analysis. JES: research adviser involved in project supervision, writing and editing the manuscript.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.