Cricothyrotomy
| Cricothyrotomy | |
|---|---|
In cricothyrotomy, the incision or puncture is made through the cricothyroid membrane in between the thyroid cartilage and the cricoid cartilage. | |
| Other names | Cric |
| ICD-9-CM | 31.1 |
| MeSH | D014140 |
| MedlinePlus | 003017 |
A cricothyrotomy (also called cricothyroidotomy or laryngotomy) is a medical procedure where an opening is created through the cricothyroid membrane to establish a patent airway during emergency airway management. Cricothyrotomy is primarily performed as the last step in airway management algorithms in cases where an airway cannot be established by other means of nasal or oral tracheal intubation.[1][2] These situations, often referred to as "cannot intubate, cannot ventilate" (CICV) or "cannot intubate, cannot oxygenate" (CICO), are commonly seen as a result of airway obstruction, angioedema, trauma, burns, or abnormal anatomy.[3]
Multiple types of cricothyrotomy may be considered for emergency surgical airway management, including surgical cricothyrotomy and needle cricothyrotomy.[4] Surgical cricothyrotomy is performed by inserting a large-bore tube through an opening in the cricothyroid membrane created via incision or using the Seldinger technique.[4] Needle cricothyrotomy is performed by inserting a catheter through the cricothyroid membrane and connecting it to a ventilation bag or a high-pressure oxygen source in a process called transtracheal jet ventilation.[4][5] Various cricothyrotomy techniques have been portrayed in popular media but should only be performed by trained medical professionals.
Although alternative surgical techniques for securing an emergency airway exist, including tracheotomy, current guidelines recommend the use of surgical cricothyrotomy as the preferred method.[2] Due to the importance of establishing an airway, there are few contraindications to performing the procedure.[6] Although complications from cricothyrotomy are possible, including failure to secure the patient's airway and bleeding, studies suggest that the rate of complications is lower than tracheostomy when performed in airway emergencies.[7][8]
While cricothyrotomy may be life-saving in extreme circumstances, this technique is only intended to be used temporarily until an alternative method can be used for long-term ventilatory support.[9]
- ^ Apfelbaum JL, Hagberg CA, Connis RT, Abdelmalak BB, Agarkar M, Dutton RP, et al. (January 2022). "2022 American Society of Anesthesiologists Practice Guidelines for Management of the Difficult Airway". Anesthesiology. 136 (1): 31–81. doi:10.1097/ALN.0000000000004002. PMID 34762729.
- ^ a b Frerk C, Mitchell VS, McNarry AF, Mendonca C, Bhagrath R, Patel A, et al. (December 2015). "Difficult Airway Society 2015 guidelines for management of unanticipated difficult intubation in adults". British Journal of Anaesthesia. 115 (6): 827–848. doi:10.1093/bja/aev371. PMC 4650961. PMID 26556848.
- ^ Nachshon A, Firman S, Batzofin BM, Miklosh B, van Heerden PV (2024). "Can't intubate, can't oxygenate? What is the preferred surgical strategy? A retrospective analysis". Anaesthesiology Intensive Therapy. 56 (1): 37–46. doi:10.5114/ait.2024.138437. PMC 11022633. PMID 38741442.
- ^ a b c Tintinalli JE, Ma OJ, Yealy DM, Meckler GD, Stapczynski JS, Cline D, Thomas S, eds. (2020). Tintinalli's emergency medicine: a comprehensive study guide. McGraw-Hill's AccessMedicine (9th ed.). New York, N.Y.: McGraw-Hill Education. ISBN 978-1-260-01993-3.
- ^ McKenna P, Desai NM, Tariq A, Morley EJ (2025). "Cricothyrotomy". StatPearls. Treasure Island (FL): StatPearls Publishing. PMID 30726035. Retrieved 2025-03-13.
- ^ Walls RM, Hockberger RS, Gausche-Hill M, Rosen P, eds. (2023). Rosen's emergency medicine: concepts and clinical practice. Elsevier. ISBN 978-0-323-75789-8.
- ^ DeVore EK, Redmann A, Howell R, Khosla S (December 2019). "Best practices for emergency surgical airway: A systematic review". Laryngoscope Investigative Otolaryngology. 4 (6): 602–608. doi:10.1002/lio2.314. PMC 6929583. PMID 31890877.
- ^ Zasso FB, You-Ten KE, Ryu M, Losyeva K, Tanwani J, Siddiqui N (August 2020). "Complications of cricothyroidotomy versus tracheostomy in emergency surgical airway management: a systematic review". BMC Anesthesiology. 20 (1): 216. doi:10.1186/s12871-020-01135-2. PMC 7450579. PMID 32854626.
- ^ Katos MG, Goldenberg D (June 2007). "Emergency cricothyrotomy". Operative Techniques in Otolaryngology-Head and Neck Surgery. 18 (2): 110–114. doi:10.1016/j.otot.2007.05.002.