n emergency surgical airway is indicated for upper airway obstruction with inability to establish the airway by other means. The efficacy of cricothyroidotomy in the adult trauma patient is well established. In general, emergency cricothyroidotomy is advocated as the emergency surgical airway procedure of choice because it is faster, simpler, and easier for **nsurgical personnel to perform than tracheotomy. Accordingly, tracheotomy is used less often in the management of the emergency airway. Although the complications of elective tracheotomy are well recognized,the pitfalls of the emergency tracheotomy have **t been fully elucidated. The purpose of this study is to examine the circumstances, complications, and outcomes of emergency cricothyroidotomy and tracheotomy in an effort to compare the relative merits of each procedure for emergency airway access in a hospital-wide setting

The medical and surgical records of 35 adult patients who received an emergency tracheotomy or cricothyroidotomy at The Johns Hopkins Hospital (Baltimore, MD) from January 1, 1993, to December 31, 1998, were reviewed. All emergency surgical airways were performed in patients with upper airway obstruction who could **t be treated with mechanical ventilation or intubation. Patients who had spontaneous ventilation and had urgent surgical airway access were excluded. Patients were identified from a computer search of the Current Procedural Termi**logy code for emergency tracheotomy (31603) and emergency cricothyroidotomy (31605), the emergency room trauma log, and the Department of Otolaryngology-Head & Neck Surgery Morbidity and Mortality conference records. Inpatient charts for 35 of the 41 patients identified were available for review. The medical records of six patients were incomplete; therefore these patients were excluded from analysis. Factors evaluated included patient demographics, underlying medical condition, etiology of airway obstruction, type of surgical airway, location of procedure, surgical service performing the procedure, and complications. Follow-up information from the electronic patient record and outpatient charts was available for 15 patients and was used to determine the incidence of long-term complications. The average follow-up time for these 15 patients was 23 months (range, 1-60 mo). Eight patients were lost to follow-up, and 12 died of an underlying medical condition.