critical care medicine
How To Do a Percutaneous Cricothyrotomy
Introduction
Cricothyrotomy, whether traditional surgical cricothyrotomy or percutaneous cricothyrotomy using a guidewire, uses an incision through the skin and cricothyroid membrane through which an artificial airway is inserted into the trachea. Cricothyrotomy is typically done emergently, when endotracheal intubation is contraindicated or unachievable by other methods of tube insertion, and non-definitive methods of airway management and ventilation (eg, extraglottic devices such as a laryngeal mask airway) fail to adequately ventilate and oxygenate the patient. (See also Airway Establishment and Control .) Cricothyrotomy using a guidewire is similar to the How To Do Femoral Vein Cannulation (catheter over guidewire) of central venous line insertion and may be more suitable for operators with limited surgical experience. Needle cricothyrotomy, a temporary method that uses a 12- to 14-gauge angiocatheter attached to a bag-valve-mask device (or a jet ventilator if available), is the preferred cricothyrotomy method for children < 10 years old. This apparatus can be easily assembled by attaching the angiocatheter to a 3-mL syringe with the plunger removed. The adapter from a 6.5-mm endotracheal (ET) tube is then attached to the syringe, and the patient is ventilated using a bag-valve-mask device attached to the ET tube adapter. 