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Cricothyrotomy, Surgical Airway Procedure for Difficult Airway

SURGICAL AIRWAY Disclaimer: While we welcome viewers from other EMS systems and the general public, please note that the content in these videos is intended primarily for internal use within HCEC. The procedures and guidelines presented should not supersede any other department's local or regional medical direction. Additionally, all human cadavers used in these demonstrations have been ethically sourced and treated with the utmost respect, in compliance with all relevant laws and ethical guidelines. CRITERIA: • Life-threatening airway compromise. • Inability to oxygenate or ventilate via OPA/NPA, BVM, EGD, or intubation. • As directed by the Difficult Airway (PR). CONTRAINDICATIONS: • Pediatrics without a clearly identified cricothyroid space (typically less than 10 years of age). • Airway obtainable by any other means. EQUIPMENT: • NAR Tracheostomy Kit, which includes: o Bougie introducer o 6.0 mm endotracheal tube (modified) o Syringe o Pen blade scalpel • 10 mL syringe • Chlorhexidine or other skin cleanser • Suction equipment and supplies • Sterile 4x4s • BVM with Oxygen • Tube holder PROCEDURE: 1. Prepare and assemble the equipment. 2. If possible, pre-oxygenate the patient. 3. Prepare the anterior neck with Chlorhexidine or other skin cleanser. 4. Locate the cricothyroid membrane. Place a finger on the thyroid cartilage (“Adam's apple”) and move the finger down into the soft depression between the thyroid cartilage and the cricoid cartilage (next firm “bump”). 5. Leave a finger on membrane. 6. Stabilize the tissue by applying finger pressure bilaterally to membrane with the hand that has identified the membrane. 7. Place the tip of the scalpel on the skin just superior to the membrane. 8. Make a vertical incision (about 4-5 cm) through the epidermis and adipose tissue over the membrane, exposing the membrane. 9. Stabilize the cricoid cartilage with thumb and forefinger, while identifying and exposing the cricoid membrane. 10. Make a horizontal incision (about 2 cm) across the membrane. 11. Insert an endotracheal introducer (bougie) caudally into the membrane via the incision. Confirm location. 12. Introduce an appropriately sized, cuffed ET Tube (less than or equal to 6.0 mm) caudally and medially over the bougie, through the incision. Inflate the cuff and remove the bougie and syringe. 13. Ventilate and confirm placement with ease of ventilation, auscultation, observation of chest wall movement, and appropriate EtCO2 waveform. 14. Secure airway with tube holder. Apply dressing to site if bleeding. 15. Contact Medical Consult and advise of the result.