Prehospital Emergency Cricothyroidotomy in Denmark: A Nationwide Cohort Study, 2016-2023.

BACKGROUND: Emergency cricothyroidotomy is a rare but potentially lifesaving rescue airway procedure in patients with failed conventional airway management. Comprehensive nationwide data on patient characteristics, procedural success and clinical outcomes remain limited, particularly for patients with out-of-hospital cardiac arrest (OHCA). METHODS: This nationwide registry-based observational cohort study included all patients undergoing prehospital emergency cricothyroidotomy in Denmark between 2016 and 2023. Cases were identified through nationwide prehospital medical records and the Danish Helicopter Emergency Medical Services database using iterative free-text searches and manual validation. OHCA patients undergoing emergency cricothyroidotomy were identified through linkage with the Danish Cardiac Arrest Register. RESULTS: A total of 71 validated prehospital emergency cricothyroidotomy cases were identified, including 48 OHCA patients and 23 patients without OHCA. Overall procedural success was achieved in 87.3% of cases, including 83.3% in patients with OHCA and 95.7% in patients without OHCA. Aspiration (32.4%) and oropharyngeal bleeding (33.8%) were the most frequent indications. Among the 48 patients with OHCA, return of spontaneous circulation was achieved in 25.0%, 30-day survival was 4.5%, and one-year survival was 2.3%. Overall, emergency cricothyroidotomy was performed in 48 of 39,885 nationwide OHCA patients (0.12%). CONCLUSION: Prehospital emergency cricothyroidotomy was an exceedingly rare procedure but demonstrated high procedural success in this nationwide physician-staffed Emergency Medical Services system. Survival among patients with OHCA was relatively low, reflecting the critical condition of patients requiring emergency cricothyroidotomy.