a. General. The primary indication to create a surgical airway is the need for an airway for a patient who cannot be intubated.
Cricothyrotomy, creation of a surgical airway, is the incision through the skin and cricothyroid membrane to secure a patient airway for emergency relief of upper airway obstruction. The word cricothyroidotomy is another name for this surgery.
The two types of cricothyrotomy are needle cricothyrotomy and surgical cricothyrotomy. The needle cricothyrotomy method is preferable in an emergency situation for a child under 12 years of age, but is still very temporary.
b. Procedure for Surgical Cricothyrotomy. Follow this procedure.
(1) Identify the cricothyroid membrane. Do this in the same way as for needle cricothyrotomy.
(2) Prepare the skin over the membrane with povidone-iodine.
(3) Puncture the cricothyroid membrane in this manner:
(a) Make a vertical skin incision over the lower one-half of the cricothyroid membrane.
(b) Carefully incise through the membrane.
(c) Insert the scalpel handle into the incision and rotate 90 degrees to open the airway.
(4) Insert the cannula or ET tube.
(a) Keep your left hand on the larynx to stabilize the larynx.
(b) Pick up the cannula in your dominant hand. Place the cannula through the puncture hole, with the cannula tip pointing toward the patient’s feet.
(c) Using controlled force, insert the cannula and advance it until the flange is flush with the skin.
(d) If you are using a cuffed tracheostomy tube, inflate the cuff.
(5) Check for correct placement.
(a) Listen and feel for air flow through the cannula.
(b) Ventilate through the cannula. The patient’s chest should rise and fall with each ventilation. The patient’s breath sounds should be audible on both sides of his chest.
(6) Secure the cannula with tape.
NOTE: Due to its potential hazards, cricothyrotomy should be performed ONLY by personnel who have been thoroughly trained in this method and who have been approved by their physician directors to use this method.