Experience Summary

Failed intubation and management of the difficult airway is a life threatening emergency. In this experience, learn the steps of an emergency cricothyroidotomy.

Clinical Context

An emergency cricothyroidotomy or ‘emergency front of neck access’ is indicated when other intubation modalities (including a supraglottic airway device and final attempts at face mask ventilation) have been unsuccessfully attempted, and the patient cannot be adequately oxygenated. This situation may occur in the operating theatre, in the Emergency Department, or during other airways emergencies (e.g. during anaphylaxis).

The difficult airway society have released guidance the management of this situation and what is required should a ‘can't intubate, can't ventilate’ situation arise.

Before performing this procedure, the following steps should be taken:

• 100% oxygen should be applied to the upper airway.
• Neuromuscular blockade should be ensured throughout the procedure.
• The patient should be positioned to extend their neck and allow adequate access to the larynx and cricothyroid membrane.

The following equipment should be assembled prior to starting the procedure:

• Scalpel (number 10 blade)
• Bougie
• Endotracheal tube (cuffed 6.0mm, checked for leaks, fully deflated and lubricated)

A laryngeal handshake should then be performed to identify the hyoid bone and stabilise the larynx. The cricothyroid membrane may then be located by palpating inferiorly down the neck. If the membrane can be identified, the steps in this video should be followed to place an endotracheal tube and successfully oxygenate the patient. Watch our associated video to view the procedure for an emergency cricothyroidotomy in a patient with an impalpable cricothyroid membrane.

Learning Outcomes

1. Understand the indications for performing an emergency cricothyroidotomy.
2. Understand the equipment required to perform an emergency cricothyroidotomy.
3. Understand the procedural steps of an emergency cricothyroidotomy in a patient with a palpable cricothyroid membrane.
   

External Resources

• Difficult Airway Society Guidelines - Difficult Intubation