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Cricothyrotomy is the creation of an opening in the cricothyroid membrane (CTM) to establish an effective airway. The primary indication is a cannot intubate-cannot ventilate scenario with actual or impending airway compromise and respiratory failure. Cricothyrotomy may be performed by passing a large bore cannula or needle through the CTM into the trachea (needle cricothyrotomy) or creating an opening through the CTM and passing an endotracheal tube or tracheostomy tube into the trachea (surgical cricothyrotomy). A needle cricothyrotomy is typically paired with jet ventilation to maintain oxygenation and is a temporizing measure because ventilation is often inadequate. Surgical cricothyrotomy is a that allows the usage of conventional modes of mechanical ventilation. Contraindications to cricothyrotomy include tracheal transection, tracheal or laryngeal trauma, and/or anatomic distortion. Surgical cricothyrotomy is also contraindicated in infants and young children. Complications include bleeding, airway trauma, and/or incorrect placement.
See also “Surgical airway management.”
Needle cricothyrotomy: the passage of a large-bore cannula through the (CTM) into the trachea
- Not a : supports oxygenation, but the ability to ventilate is limited 
- Most commonly used with . 
- Surgical cricothyrotomy: the passage of a tube into the trachea via an incision through the skin, cervical fascia, and CTM; provides a definitive airway.
The most common indication is a CICV) scenario (e.g., after ), however, can be considered early in in select situations.(
- Needle cricothyrotomy
- Surgical cricothyrotomy 
- Tracheal transection
- Severe laryngeal injury
Surgical cricothyrotomy 
- Infection at the site
- Distorted anatomy
The ability to perform safe and timely endotracheal intubation is a contraindication to cricothyrotomy.
Tracheostomy is preferred for patients who need a permanent without imminent , or if is absolutely contraindicated.
We list the most important contraindications. The selection is not exhaustive.
The following applies totechnique: 
- Sterile gloves and PPE
- Antiseptic solution
- Sterile drape
- Local anesthetic with epinephrine
- Syringe and small-gauge needle for local anesthetic
- Scalpel (e.g., No. 11, 20, or 10)
- Angled gum elastic bougie
- Appropriately sized tube
- Sterile gauze
- ETCO2 detector
- Self-inflating manual ventilation bag
- Position the patient supine with their neck extended.
- Provide oxygen to the mouth and nose.
- Identify the CTM landmarks: the depression between the thyroid cartilage and cricoid cartilage
- Don PPE and sterile gloves.
- Perform skin preparation.
- Apply sterile drape (if time permits).
- Additional steps for surgical cricothyrotomy:
- Administer local anesthesia (if the patient is conscious and time permits).
- Apply a small amount of lubricant to the inside of the tube.
Surgical cricothyrotomy 
Stab-twist-bougie-tube cricothyrotomy 
- Grasp the cricoid cartilage between the middle finger and thumb of the nondominant hand.
- Locate the CTM with the index finger.
- Make an ∼ 1.5 cm-wide transverse incision through the skin, subcutaneous tissue, and CTM.
- Turn the scalpel 90° to open the incision.
- Insert the bougie (angled end first) directed toward the patient's feet.
- Advance the bougie 10–15 cm.
- Withdraw the scalpel.
- Thread the lubricated tube over the bougie.
- Advance the tube just until the cuff is no longer visible.
- Inflate the tracheal tube cuff.
- Remove the bougie and attach a self-inflating bag.
- Verify intratracheal placement with positive EtCO2.
Pitfalls and troubleshooting
|Common pitfalls and challenges of cricothyrotomy |
|Unable to identify landmarks |
(occurs when using)
|Incorrect tube placement|| |
|Distal airway pathology|| |
|Bleeding || || |