Makindo Medical Notes

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

• Surgical Cricothyroidotomy – StatPearls (NCBI)
• Life in the Fast Lane – Cricothyroidotomy