Surgical cricothyroidotomy should be conducted in any patient where intubation has been attempted twice and failed and/or the patient cannot be ventilated.
1 Hyperextend the neck, making the patient comfortable.
2 Identify the groove between the cricoid and thyroid cartilages just below the “Adam’s apple” (the protruding thyroid).
3 Clean the area and infiltrate with local anaesthetic.
4 Incise through the skin vertically with a 1.5 cm cut and use blunt dissection to ensure that you can see the membrane between the thyroid and cricoid
5 With a #22 or #23 scalpel blade, stab through the membrane into the hollow trachea.
6 Rotate the blade 90° , insert a curved artery forceps alongside the blade, remove the blade and open the forceps side to side, widening the space between the thyroid and cricoid cartilages
7 Pass a thin introducer or a nasogastric tube into the trachea if very small access
8 Run a 4–6 endotracheal tube over the introducer and pass it into the trachea
9 Remove the introducer, if used.
This tube can stay in place for up to 3 days. Do not attempt this procedure in a child under the age of 10 years; passing several needles through the membrane will give enough air entry.
This procedure should be performed by an experienced person, with prior knowledge of the anatomy and medical condition of the patient. This procedure should not be undertaken bleeding and delay can cause death.