After an emergency cricothyrotomy, the complications are mostly swallowing and voice

Design

retrospective single-centre case series

Population

48 patients undergoing emergency cricothyrotomy at a level one trauma centre, 2014-2025; mean age 57.7 years

Primary outcome

short-term and long-term complications after cricothyrotomy

Effect

in-hospital mortality 20.8% and 90-day 29.2%; dysphagia 35.4%, pneumonia 31.3%, dysphonia 27.1%; long term persistent dysphagia 18.8%, subglottic stenosis 12.5%, vocal fold injury 10.4%; decannulation in 41.7% at a mean 83.7 days

Forty-eight patients who had emergency cricothyrotomy at a level one trauma centre between 2014 and 2025 were reviewed for short- and long-term outcomes. Mean age was 57.7 years and 72.9% were male.

Mortality reflects the circumstances rather than the procedure: 20.8% in hospital and 29.2% at ninety days. Among survivors, the short-term problems were dysphagia in 35.4%, pneumonia in 31.3% and dysphonia in 27.1%. Planned conversion to tracheostomy happened in 83.3%, on average 2.3 days later, and time to conversion was longer in patients who developed pneumonia (3.9 against 1.4 days, P=0.005). Longer term, 18.8% had persistent dysphagia, 12.5% subglottic stenosis and 10.4% vocal fold injury. Twenty patients (41.7%) were eventually decannulated, at a mean of 83.7 days. One in five returned to the emergency department within thirty days.

Forty-eight patients from one centre cannot establish much, and the association between delayed conversion and pneumonia runs at least as plausibly in the other direction - a patient developing pneumonia is a patient too unstable to take to theatre. What the series does provide is a realistic list for follow-up. Subglottic stenosis in one in eight and persistent dysphagia in one in five are not rare enough to leave to chance, and a patient who has survived a cricothyrotomy is often discharged from a trauma service with no ENT follow-up arranged at all.

• Arrange ENT follow-up before discharge for every cricothyrotomy survivor - subglottic stenosis affected one in eight
• Assess swallowing formally rather than by observation; persistent dysphagia affected nearly one in five at long-term follow-up
• Document voice at follow-up - dysphonia was present in over a quarter early on
• Convert to tracheostomy on a planned basis as soon as the patient is stable enough, rather than by drift
• Warn the patient and family that decannulation, where it happens, took a mean of nearly three months

Why it matters

It converts a procedure remembered as an airway rescue into a follow-up problem with a predictable shape.

Don't overread it

A single-centre retrospective series of 48 patients - it describes complication frequencies, and the pneumonia association is very likely confounded by severity.

The statistics, in plain English

Forty-eight patients means every percentage in this series moves by about two points for each additional case, so figures such as 12.5% for subglottic stenosis should be read as roughly one in eight rather than as a precise rate. The pneumonia and delayed-conversion association (3.9 against 1.4 days, P=0.005) is the one to be most careful with: in a retrospective series, the sicker patient is both the one who gets pneumonia and the one whose conversion is postponed, so this does not show that delay causes pneumonia.

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