What is a Cricothyroidotomy?

S. Blake

A cricothyroidotomy is an emergency airway puncture used to provide emergency access to a patient's airway via the cricothyroid membrane, a small, soft indentation located on the neck, just below the thyroid cartilage, or Adam's apple. This procedure typically is performed only when orotracheal and nasotracheal intubation attempts have failed. Additional indications for this procedure include severe facial or nasal injuries, midfacial trauma, anaphylaxis, inhalation injuries or cervical spinal trauma.

Nail clippers, which can be used for an emergency cricothyroidectomy.
Nail clippers, which can be used for an emergency cricothyroidectomy.

In a sterile controlled environment, materials used in a cricothyroidotomy would include sterilizing solution, sponges, a scalpel blade and lidocaine, but if a patient needs an airway in an uncontrolled environment, the supplies used will be limited to what is on hand. A sharp instrument such as a pocket knife, razor blade, scissors or broken glass could be used to perform an emergency cricothyroidotomy. A hollow tube will be necessary to keep the airway open. Examples of emergency tube-like structures include but are not limited to a ball point pen barrel, nail clippers, a bent paper clip or two keys with one turned sideways.

The cricothyroid lies between the thyroid cartilage and cricoid cartilage.
The cricothyroid lies between the thyroid cartilage and cricoid cartilage.

Performing a cricothyroidotomy should be done only by trained medical personnel. In an emergency situation, minimally trained individuals can perform a successful cricothyroidotomy. Medical attention should be sought as quickly as possible when this occurs.

The emergency procedure is begun with correctly identifying the cricothyroid membrane. A transverse incision is made directly over the cricothyroid membrane. After the skin is open and exposed, a sharp instrument is pushed directly down through the cricothyroid membrane. After the trachea is entered, a distinct "pop" will be heard. The hollow tube should then replace the sharp instrument, and the patient's airway should then be open.

If this procedure is done in a sterile and closed environment, the skin would first be sterilized, and the skin would then be anesthetized. The incision would be performed using a surgical blade, clamps would hold the airway open, a tracheotomy tube would be inserted, and the patient would be ventilated with a bag valve unit. The emergency and sterile forms of this procedure are vastly different, but they can produce the same life-saving results if performed correctly.

A cricothyroidotomy is also commonly referred to as a cricothyrotomy, a thyrocricotomy, an inferior laryngotomy or an intercricothyrotomy. If performed successfully, this procedure generally has few complications. The neck contains many nerves and blood vessels, however, and a general knowledge of basic anatomy is needed to avoid harming the patient.

A cricothyroidotomy involves making an emergency puncture just below the Adam's apple.
A cricothyroidotomy involves making an emergency puncture just below the Adam's apple.

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