Cricothyrotomy

A cricothyrotomy (also called cricothyroidotomy or laryngotomy) is a medical procedure where an opening is created through the cricothyroid membrane to establish a patent airway during emergency airway management. Cricothyrotomy is primarily performed as the last step in airway management algorithms in cases where an airway cannot be established by other means of nasal or oral tracheal intubation. These situations, often referred to as "cannot intubate, cannot ventilate" (CICV) or "cannot intubate, cannot oxygenate" (CICO), are commonly seen as a result of airway obstruction, angioedema, trauma, burns, or abnormal anatomy.

Multiple types of cricothyrotomy may be considered for emergency surgical airway management, including surgical cricothyrotomy and needle cricothyrotomy. Surgical cricothyrotomy is performed by inserting a large-bore tube through an opening in the cricothyroid membrane created via incision or using the Seldinger technique. Needle cricothyrotomy is performed by inserting a catheter through the cricothyroid membrane and connecting it to a ventilation bag or a high-pressure oxygen source in a process called transtracheal jet ventilation. Various cricothyrotomy techniques have been portrayed in popular media but should only be performed by trained medical professionals.

Although alternative surgical techniques for securing an emergency airway exist, including tracheotomy, current guidelines recommend the use of surgical cricothyrotomy as the preferred method. Due to the importance of establishing an airway, there are few contraindications to performing the procedure. Although complications from cricothyrotomy are possible, including failure to secure the patient's airway and bleeding, studies suggest that the rate of complications is lower than tracheostomy when performed in airway emergencies.

While cricothyrotomy may be life-saving in extreme circumstances, this technique is only intended to be used temporarily until an alternative method can be used for long-term ventilatory support.