Surgical and Nonsurgical Cricothyrotomy

DR AQEELA BANOEMS 352

Surgical and Nonsurgical Cricothyrotomy

• Used when conventional techniques fail

• Be familiar with:– Anatomy of the

anterior aspect of the neck

– Important blood vessels in area

Open Cricothyrotomy

• Involves:– Incising the cricothyroid membrane– Inserting an ET or tracheostomy tube directly into

the subglottic area of the trachea• Cricothyroid membrane is ideal for surgical

opening into the trachea

Open Cricothyrotomy

• Several types:– Open (surgical)

cricothyrotomy– Modified

cricothyrotomy (Seldinger technique)

– Device that functions as an introducer and an airway

Courtesy of Cook Medical

Open Cricothyrotomy

• Indications– Patent airway cannot

be secured with conventional means

• Severe foreign body obstructions

• Swelling of airway • Maxillofacial trauma• Inability to open

mouth

Open Cricothyrotomy

• Contraindications – Ability to secure a patent airway – Inability to identify anatomic landmarks – Crushing injuries to the larynx and tracheal

transection– Underlying anatomic abnormalities – Age younger than 8 years

Open Cricothyrotomy

• Advantages– Can be performed quickly– Do not need to manipulate cervical spine

• Disadvantages – Difficult to perform in children and patients with short, muscular, or

fat necks– More difficult than needle cricothyrotomy

Open Cricothyrotomy

• Complications– Severe bleeding from laceration of the external

jugular vein.– Risks of perforating the esophagus and damaging

the laryngeal nerves– Taking too long will result in hypoxia– Subcutaneous emphysema from tube

misplacement

Open Cricothyrotomy Equipment

• If a commercial kit is not available, prepare:– Scalpel– ET or tracheostomy tube – Commercial device (or tape) to secure tube– Curved hemostats– Suction apparatus– Sterile gauze pads – Bag-mask device attached to 100% oxygen

Technique for Performing Open Cricothyrotomy

• Proceed rapidly yet cautiously• Palpate for V notch of thyroid cartilage• Slide index finger into depression between

thyroid and cricoid cartilage– That is the cricothyroid membrane.

Technique for Performing Open Cricothyrotomy

• Partner prepares equipment• Maintain aseptic technique. • Stabilize larynx; make a 1- to 2-cm vertical

incision over the cricothyroid membrane.

Technique for Performing Open Cricothyrotomy

• Insert a 6.0-mm cuffed ET tube or a 6.0 tracheostomy tube into trachea.

• Inflate the distal cuff.• Attach the bag-mask device, and ventilate

while your partner auscultates.

Technique for Performing Open Cricothyrotomy

• Confirm proper tube placement.• Ensure bleeding has been controlled.• Secure tube and continue to ventilate.

Needle Cricothyrotomy

• 14- to 16-gauge over-the-needle IV catheter inserted into the trachea

• High-pressure jet ventilator attached to catheter hub– Translaryngeal catheter ventilation

Needle Cricothyrotomy

• Indications– Inability to ventilate by less invasive means– Maxillofacial trauma– Inability to open mouth– Uncontrolled oropharyngeal bleeding

• Contraindications– Severe airway obstruction above catheter insertion

• High-pressure ventilator leads to barotrauma and pneumothorax– If equipment is not immediately available

Needle Cricothyrotomy

• Advantages– Easier than open

cricothyrotomy– Lower risk of damaging

structures– Allows for intubation– No manipulation of cervical

spine

• Disadvantages– Does not provide

protection from aspiration– Technique requires a

specialized, high-pressure jet ventilator

Needle Cricothyrotomy

• Complications– Improper placement can cause severe bleeding.– Excessive air leakage can cause subcutaneous

emphysema and compression of the trachea. – Overinflation of lungs: barotrauma– Underinflation of lungs: hypoventilation

Needle Cricothyrotomy Equipment

• Large-bore IV catheter (14–16 gauge)• 10-mL syringe• 3 mL of sterile water or saline• Oxygen source (50 psi)• High-pressure jet ventilator device and oxygen

tubing

Technique for Performing Needle Cricothyrotomy

• Draw up approximately 3 mL of sterile water or saline into a 10-mL syringe.– Attach to IV catheter.

• Place head in neutral position• Locate the cricothyroid membrane.• Cleanse area if time permits.

Technique for Performing Needle Cricothyrotomy

• Stabilize the larynx; insert the needle at a 45° angle toward the feet.– You should feel a pop as the needle penetrates the

membrane. • After a pop is felt, insert needle 1 cm farther;

aspirate with the syringe.

Technique for Performing Needle Cricothyrotomy

• Advance catheter over needle until catheter hub is flush with skin– Withdraw the needle; dispose of properly.

• Attach one end of the oxygen tubing to the catheter; other end to the jet ventilator

Technique for Performing Needle Cricothyrotomy

• Begin ventilations by opening the release valve on the jet ventilator– Turn release valve off with chest rise.

• Secure catheter and continue ventilations.

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