King Saud University

College of Nursing

Needle
cricothyroidoto
my

Hatem Alsrour
A cricothyrotomy (also called thyrocricotomy, cricothyroidotomy, inferior
laryngotomy, intercricothyrotomy, coniotomy or emergency airway
puncture) is an emergency incision through the skin and cricothyroid membran
to secure a patient's airway during certain emergency situations, such as an
airway obstructed by a foreign object or swelling, a patient who is not able to
breathe adequately on their own, or in cases of major facial truma which
prevent the insertion of an airway through the mouth. A cricothyrotomy is
usually performed by emergency physicians , trauma surgeons, or paramedics
as a last resort when control of the airway by usual means (an endotrachial
tube through the mouth) have failed or are not feasible. This technique is
considered easier and faster than a trachiostomy, but is only used when oral or
nasal intubation is not possible. This procedure does not require manipulation
of the cervical spine. However, it does require special training and authorization
from local medical direction prior to being performed, depending on local
medical protocol.

There are three techniques:

Needle
Intubation (with purpose-built kits)
Surgical
Procedure:

In a needle cricothyroidotomy, a
syringe with a needle attached is
used to make a puncture hole
through the cricothyroid
membrane that overlies the
trachea. After the needle has
reached the trachea, a catheter
is passed over the needle into
the windpipe and attached to a
bag-valve device.
ppppppppppppppppppppppppppppppppppppppppppppppp
iiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiii
oooooooooooooooooooooooooooooooooooooooooooooooo
 Indications:
Intubation is not possible via the oral or
nasal route
Need to avoid neck manipulation (e.g.
basal skull/cervical spine injury or
fracture)
Severe maxillofacial trauma
Severe oropharyngeal/tracheobronchial
haemorrhage
Foreign body in upper airway
Lack of equipment for endotracheal
intubation
Technical failure of intubation
 Burns in or around the mouth
Contraindications:
Inability to identify landmarks
(cricothyroid membran)
Underlying anatomical
abnormality (tumer)
Tracheal transection
Acute laryngeal disease due to
infection or trauma
Laryngeal fracture
Risks:
The risks of a needle cricothyroidotomy include:

external scar from needle puncture

bleeding

accidental perforation of the esophagus

hypercarbia (overly high levels of carbon

dioxide in the blood)