Cricothyrotomy

In cricothyrotomy, the incision or puncture is made through the cricothyroid membrane in between the thyroid cartilage and the cricoid cartilage.

A cricothyrotomy (also called thyrocricotomy, cricothyroidotomy, inferior laryngotomy, intercricothyrotomy, coniotomy or emergency airway puncture) is an emergency incision through the skin and cricothyroid membrane to secure a patient's airway during certain emergency situations, such as an airway obstructed by a foreign object or swelling, a patient who is not able to breathe adequately on their own, or in cases of major facial trauma which prevent the insertion of an endotracheal tube through the mouth. A cricothyrotomy is usually performed by emergency physicians, surgeons, field medics, or paramedics. Usually it is performed as a last resort when control of the airway by usual means (an endotracheal tube through the mouth) have failed or are not feasible. This technique is considered easier and faster than a tracheostomy, but is only used when oral or nasal intubation is not possible. This procedure does not require manipulation of the cervical spine. However, for a non-physician, it does require special training and authorization from local medical direction prior to being performed, depending on local medical protocols.

Cricothyrotomy is only a temporary airway for life-saving situations. It is not suitable for prolonged ventilation due to its small size. A definitive airway (tracheostomy or endotracheal intubation) must be performed later in hospital.

Indications

• Can't intubate Can't ventilate
• Severe facial or nasal injuries (that do not allow oral or nasal intubation)
• Massive midfacial trauma
• Possible cervical spine trauma preventing adequate ventilation
• Anaphylaxis
• Chemical inhalation injuries

Contraindications

• Inability to identify landmarks (cricothyroid membrane)
• Underlying anatomical abnormality (tumor)
• Tracheal transection
• Acute laryngeal disease due to infection or trauma
• Small children under 10 years old (a 12–14 gauge catheter over the needle may be safer)

Procedure

In cricothyrotomy, the incision or puncture is made through the cricothyroid membrane in between the thyroid cartilage and the cricoid cartilage.

The procedure was first described in 1805 by Vicq d'Azyr, a French surgeon and anatomist. A cricothyrotomy is generally performed by making a vertical incision on the skin of the neck just below the "Adam's apple", or thyroid cartilage, then making another transverse incision in the cricothyroid membrane which lies deep to this point. One then inserts a tube into this opening, which allows one to breathe for the patient with a machine or bag.

Summarized technique

1. With a scalpel, create a 1 cm vertical incision through the skin and the cricothyroid membrane
2. Open the hole by inserting the scalpel handle into the wound and rotating 90 degrees or by using a clamp
3. Insert a 6 or 7 mm Internal Diameter tracheostomy tube or endotracheal tube
4. Inflate the cuff and secure the tube
5. Provide venilation via a bag-valve device with the highest available concentration of oxygen
6. Determine if ventilation was successful (bilateral ausculation and observing chest rise and fall)
7. No attempt should be made to remove the tracheostomy or endotracheal tube in a prehospital setting

See also

• Laryngotomy
• Tracheotomy

References

External links

• Drawing of a cricothyrotomy
• Smiths Medical (Cricothyroidotomy products for Adults and Children)
• Medstudents: Procedures: Cricothyrotomy