Surgical
Cricothyroidotomy
{
A simple approach to a difficult airway
Surgical
characteristic of or resembling surgery
or a surgeon especially in control or
incisiveness.
Cricothyroid
: a membrane of yellow elastic tissue
that is attached below to the cricoid
cartilage, in front to the thyroid
cartilage, and in the back to the
arytenoid cartilages and that forms the
vocal ligaments with its thickened upper
margins
Otomy
-suffix meaning “to make an
incision or cut into
Surgical
Cricothyroidotomy :
An emergency procedure involving
incising or puncturing the cricothyroid
membrane to access the trachea for
ventilation purposes.
Indications:
Facial Trauma
Oropharyngeal Edema
Failed Airway
Inability to Intubate (includes BLS
airways…)
Inability to Ventilate
Contraindications
-Pediatrics < 8 years of age
Procedure
1. Determine Need
- BVM ventilation?
- BLS Airway?
-Advanced BLS Airway?
-EndoTracheal Intubation?
-Physical Indications?
2. Assemble Equipment
- 6.0 Endotracheal tube w/ 10cc syringe
- Scalpel
- Bougie
- Hemostats or Magill Forceps
- Tube securing device
- Bag-Valve-Mask
- Capnography or CO2 Detection
- Betadine or Providone Iodine Swab
3. Landmark
- Extend the patient’s neck (unless
cervical spine injury is suspected).
- Locate the cricothyroid membrane
between the cricoid and thyroid
cartilages by palpating the depression
caudal (towards the feet) to the midline
Adam’s Apple.
3.1 Difficult Landmarks
- Women
- Obese
- Previous neck surgery or trauma
- Abnormal neck anatomy
4. Clean the area
- Betadine
- Providone Iodine Swab
5. Landmark and Stabilize
- Confirm Landmark
- Stabilize the area to be incised by
stretching skin laterally across
membrane with thumb and
forefinger of non-dominant hand.
6. Make the incision
- Vertical
- Approximately ½ - ¾ inch
- Enter the tracheal airway
7. Insert the Bougie
- Leave the scalpel in place
- Bougie inserted caudally with
coude tip first
- Feel for tracheal rings “clicks”.
8. Digital Dilation of the
Incision
- Remove Scalpel leaving Bougie in
place
- Use 5th digit (Pinky) to dilate
incision slightly
- Hemostats or Magills?
9. Insert ETT Tube
- 6.0 ETT inserted
- Balloon inserted completely through
the incision/ membrane
- Inflation of the balloon
- MAINTAIN CONTROL OF THE
TUBE!!
10. Confirm and Secure
- Auscultation
- Capnography
- Compliance
- Appropriate securing device
Complications
- Bleeding
- Bleeding
- Bleeding
- Landmarks
- Incision depth
- Loss of incision site
- Incision size / difficulty passing ETT
Questions?