Airway Management in Tactical Combat Casualty Care: TCCC Change 24-1.

Abstract

Tactical Combat Casualty Care (TCCC) has been designated by the U.S. Department of Defense as the military standard for battlefield trauma care. The TCCC Guidelines are a set of evidence-based, best-practice recommendations for combat medical personnel to use in caring for casualties on the battlefield prior to their arrival at a medical treatment facility. In 2024, the Committee on TCCC approved a change to the recommended management of the airway in TCCC. This change to the TCCC Guidelines does the following: - Continues the recommendation for use of the "Sit-Up and Lean-Forward" positioning to keep the airway clear in casualties with direct maxillofacial trauma when the casualties are conscious and able to do so. - Recommends the removal of the extraglottic airway as an airway adjunct. - Recommends that casualties who are unconscious but do not have a traumatic airway obstruction be placed in the recovery position with the chin tilted away from the chest. There is no longer a recommendation to use the "jaw thrust." - Recommends the removal of the Control-Cric as the preferred cricothyroidotomy device. - Recommends continuous capnography monitoring for casualties who have a cricothyroidotomy performed, in order to provide initial and ongoing assurance that the cricothyrotomy tube is positioned correctly. - Adds an oxygenation and ventilatory support note at the end of the respiratory/breathing section of Tactical Field Care. - Adds a recommendation in the Respirations/Breathing section that in the case of impaired ventilation and uncorrectable hypoxia with an oxygen saturation less than 90%, a properly sized nasopharyngeal airway should be considered when performing bag valve mask ventilations. - Adds a recommendation in the Respirations/Breathing section that states that in the case of impaired ventilation and uncorrectable hypoxia with an oxygen saturation less than 90%, the casualty should be ventilated with a 1,000mL resuscitator bag valve mask. - Removes recommendations for airway management in the Tactical Evacuation Care phase of care, as responsibility for that phase of care has been shifted to the Committee on Enroute Combat Casualty Care.