Needle cricothyrotomy

Indications

• Failed airway in adults or children
  • Preferred method of rescue airway in infants and children (cutoff 5-12 years of age, depending on source)
• Temporizing measure until definitive airway management
• Obstruction above the level of the cricothryoid membrane

Contraindications

When used as a rescue airway, no absolute contraindications.

• Relative Contraindications
  • Inability to identify landmarks
  • Tracheal transection or severe trauma
  • Underlying tumor, abscess/infection, or other known abnormality

Equipment

• Provodone iodine
• Sterile drapes, gloves, gown, gauze
• 12-14 G angiocath
• 3mL syringe x 2
• Adapter to 7-0 ETT or adapter to 3-0 ETT
• BVM appropriate for size of patient
  • Can also use jet vet ventilation setup in adults
    • High flow O2 source, 50 PSI
    • O2 tubing
    • Valve-3 way stop cock or cut holes in O2 tubing
    • Depending on O2 source, calculate time valve must be open for tidal volume
    • BVM setup does not allow adequate exhalation in adults

Procedure

1. Prep and drape
2. Locate cricothyroid membrane
3. Pierce membrane with angiocath directed 30-45 deg caudal
   • Attach 3mL syringe with saline, aspirate as you enter
   • Advance until air is aspirated in syringe
4. Advance catheter over needle, hub to skin
   • Remove needle
5. Attach 3 mL syringe to catheter, then attach 7-0 ETT adapter to syringe
   • Or can attach 3-0 ETT adapter directly to angiocath
6. Attach BVM to ETT adapter
7. Secure system
8. Ventilate with BVM or high flow O2 setup
9. OBTAIN DEFINITIVE AIRWAY
   • Should be used for < 45 minutes

Complications

• Hemorrhage
• Infection
• Tracheal stenosis
• Subcutaneous emphysema
• Posterior tracheal perforation

See Also

• Intubation
• Surgical cricothyrotomy

References

Authors

Ross Donaldson