Cricothyroidotomy

Cricothyrotomy
Intervention
In cricothyrotomy, the incision or puncture is made through the cricothyroid membrane in between the thyroid cartilage and the cricoid cartilage.
ICD-9-CM	31.1
MeSH	D014140
MedlinePlus	003017
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A cricothyrotomy (also called crike, thyrocricotomy, cricothyroidotomy, inferior laryngotomy, intercricothyrotomy, coniotomy or emergency airway puncture) is an incision made through the skin and cricothyroid membrane to establish a patent airway during certain life-threatening situations, such as airway obstruction by a foreign body, angioedema, or massive facial trauma. Cricothyrotomy is nearly always performed as a last resort in cases where orotracheal and nasotracheal intubation are impossible or contraindicated. Cricothyrotomy is easier and quicker to perform than tracheotomy, does not require manipulation of the cervical spine, and is associated with fewer complications. However, while cricothyrotomy may be life-saving in extreme circumstances, this technique is only intended to be a temporizing measure until a definitive airway can be established.

A cricothyrotomy is often used as an airway of last resort given the numerous other airway options available including standard tracheal intubation and rapid sequence induction which are the common means of establishing an airway in an emergent scenario. Cricothyrotomies account for approximently 1% of all emergency department intubations, and is used mostly in persons who have experienced a traumatic injury.

Some general indications for this procedure include:

The procedure was first described in 1805 by Félix 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 laryngeal prominence (Adam's apple), then making another transverse incision in the cricothyroid membrane which lies deep to this point. A tracheostomy tube or endotracheal tube with a 6 or 7 mm internal diameter is then inserted, the cuff is inflated, and the tube is secured. The person performing the procedure might utilize a bougie device, a semi-rigid, straight piece of plastic with a one inch tip at a 30 degree angle, to provide rigidity to the tube and assist with guiding its placement. Confirmation of placement is assessed by bilateral ausculation of the lungs and observation of the rise and fall of the chest.