Introduction Emergent cricothyrotomy is a life-saving surgical procedure employed when conventional intubation fails. Scenarios requiring cricothyrotomy are uncommon, and many trainees have limited experience with the procedure. As “cannot intubate, cannot oxygenate” scenarios demand rapid intervention, it is crucial that providers quickly recognize patients at risk for difficult intubation. This study investigates pre-morbid commonalities among patients who underwent cricothyrotomy at a tertiary care, level one trauma center to improve identification of difficult intubation scenarios that may require cricothyrotomy. Methods A retrospective analysis of the demographic, clinical, and procedural data of 32 patients who underwent emergent cricothyrotomy at our institution between 2014 and 2025 was performed. Descriptive statistics were analyzed to characterize the patient cohort. Results Common pre-morbid conditions in our series included COPD, asthma, and head and neck cancer. The leading indications for attempted intubation were angioedema, obstructive tumor, trauma, and acute respiratory failure. Laryngoscopy revealed airway edema and blood as the primary factors obscuring the airway, preventing intubation and prompting the need for cricothyrotomy. Conclusions Patients with limited respiratory reserve capacity such as in COPD and asthma as well as those with distorted airway anatomy secondary to malignancy, radiation fibrosis, or post-surgical changes are at higher risk for failed intubation attempts leading to eventual cricothyrotomy. Early recognition of risk factors may lead to improved airway management planning which, in some cases, may mitigate the need for emergent cricothyroidotomy.
