| Mr. Ibrahem/Cricothyrotomy | |
|---|---|
 In cricothyrotomy, the incision or puncture is made through the cricothyroid membrane, between the thyroid and cricoid cartilage. Should be horizontal rather than vertical. | |
| Other names | Cric, crike, thyrocricotomy, cricothyroidotomy, inferior laryngotomy, intercricothyrotomy, coniotomy, emergency airway puncture, emergency surgical airway |
| Specialty | Emergency medicine |
| Complications | Bleeding, infection, fistula formation[1] |
Cricothyrotomy is a cut through the skin and cricothyroid membrane to establish an airway when other means of ventilating a person, such as intubation and bag valve mask fail.[4] This may include in the setting of excessive bleeding within the mouth or facial trauma.[4]
While the procedure can be done in a number of ways, a common technique is the "scalpel-finger-bougie".[4] The first step is locating the cricothyroid membrane (CTM) between the thyroid and cricoid cartilage.[4] A 4 cm vertical cut is made through the skin.[4] A horizontal cut is made through the CTM.[4] A finger and then a bougie is placed in the hole.[4] A 6.0 ET tube is then placed over the bougie until the cuff just disappears at which point it is inflated.[4] In children a 4.0 ET tube may be used.[6]
Signs of success include end-tidal CO2 and chest rise on both sides.[4][1] The ET tube is than secured in place.[4] In those at high risk, set up for a cricothyrotomy may be done before starting intubation.[1] The procedure is not recommended in those under the age of 5 to 12 years, though jet ventilation may be done in younger people.[2][3][5] Cricothyrotomy is easier to perform than a tracheotomy, though this procedure may be performed at a later date.[4][2]
Use has become less common due to other improvements in airway management.[2] In the emergency room, they are carried out in less than 3 in 1,000 intubations, with most being done due to trauma.[7] The procedure was first formally carried out in 1909, though did not come into common use until the 1970s.[4] The average time to perform the procedure is just over a minute.[1]
References
edit- ^ a b c d e "Surgical Cricothyroidotomy • LITFL Medical Blog • CCC Airway". Life in the Fast Lane • LITFL. 1 January 2019. Archived from the original on 10 April 2021. Retrieved 18 March 2021.
- ^ a b c d e M. Gregory Katos; David Goldenberg (June 2007). "Emergency cricothyrotomy". Operative Techniques in Otolaryngology. 18 (2): 110–114. doi:10.1016/j.otot.2007.05.002. Archived from the original on 28 August 2021. Retrieved 25 July 2010.
- ^ a b "How To Do a Percutaneous Cricothyrotomy - Critical Care Medicine". Merck Manuals Professional Edition. Archived from the original on 17 January 2021. Retrieved 18 March 2021.
- ^ a b c d e f g h i j k l m n McKenna, P; Desai, NM; Morley, EJ (January 2021). "Cricothyrotomy". PMID 30726035.
{{cite journal}}: Cite journal requires|journal=(help) - ^ a b Mace SE, Khan N (2008). "Needle cricothyrotomy". Emerg Med Clin North Am. 26 (4): 1085–101, xi. doi:10.1016/j.emc.2008.09.004. PMID 19059102. Archived from the original on 2021-08-28. Retrieved 2022-03-14.
- ^ Berger-Estilita, J; Wenzel, V; Luedi, MM; Riva, T (6 April 2021). "A Primer for Pediatric Emergency Front-of-the-Neck Access". A&A practice. 15 (4): e01444. doi:10.1213/XAA.0000000000001444. PMID 33821828.
- ^ Offenbacher, J; Nikolla, DA; Carlson, JN; Smith, SW; Genes, N; Boatright, DH; Brown CA, 3rd (June 2023). "Incidence of rescue surgical airways after attempted orotracheal intubation in the emergency department: A National Emergency Airway Registry (NEAR) Study". The American journal of emergency medicine. 68: 22–27. doi:10.1016/j.ajem.2023.02.020. PMID 36905882.
{{cite journal}}: CS1 maint: numeric names: authors list (link)