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Surgical Cricothyroidotomy
Related Subjects: | Airway Obstruction | Surgical Cricothyroidotomy | Rapid Sequence Induction
Surgical cricothyroidotomy is a lifesaving procedure that should only be performed by those who are formally trained. It establishes a definitive airway when intubation has failed.
📖 About
- 🚨 Potentially lifesaving in “can’t intubate, can’t oxygenate” scenarios.
- ✅ Provides oxygenation and ventilation via a direct airway.
🛠 Adjuncts: Considering Front of Neck Airway
📌 Indications
- Failed airway: unable to intubate, unable to ventilate.
- Severe upper airway obstruction preventing other routes.
🔪 Procedure (summary)
- Local anaesthesia with lidocaine ± adrenaline if time allows.
- Make a horizontal incision through the cricothyroid membrane.
- Use tracheal dilators or scalpel-bougie technique to open the incision.
- Insert a small endotracheal tube (≈6 mm) or tracheostomy tube.
- Inflate cuff and secure tube.
- Confirm position with:
- Capnography (gold standard).
- Chest rise and auscultation.
✅ Benefits
- Creates a definitive, secure airway.
- Allows suctioning of the trachea and long-term ventilation if needed.
⚠️ Risks
- Trauma to thyroid gland, blood vessels, or tracheal wall.
- Creation of a false passage (false lumen).
- Technically more difficult in obese patients or distorted anatomy.
📚 References
🧾 Clinical Case – Surgical Cricothyroidotomy
A 54-year-old man is brought to the emergency department after a high-speed road traffic accident with massive maxillofacial trauma and severe oropharyngeal bleeding. Attempts at orotracheal intubation fail due to distorted anatomy, and the patient rapidly desaturates despite bag-valve-mask ventilation. A surgical cricothyroidotomy is performed via a vertical incision through the cricothyroid membrane, allowing insertion of a cuffed tube and immediate oxygenation. 👉 Diagnosis: can't intubate, can't oxygenate scenario. 👉 Management: definitive airway established via emergency surgical cricothyroidotomy, followed by ICU admission and later conversion to tracheostomy.
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