The emergency airway

Abstract

The 'can't intubate, can't ventilate' scenario is a nightmare for all clinicians who manage airways. Cricothyroidotomy is one of several emergency airway management techniques. Cricothyroidotomy is a short-term solution which provides oxygenation, not ventilation, and is not a definitive airway. Although there are tests which can help predict whether an intubation will be difficult, they are not always good predictors. As the can't intubate, can't ventilate scenario is rare, cricothyroidotomy is an unfamiliar procedure to many. In this situation, expert help must be called for early on. In the meantime, it is vital that all other simple airway manoeuvres have been attempted, such as good positioning of the patient with head tilt and chin lift, and use of airway adjuncts like the oral (Guedel) airway or nasopharyngeal airway, and the laryngeal mask airway. However, if attempts to secure the airway are unsuccessful, there may be no other option than to perform a cricothyroidotomy. It is a difficult decision to make, but with increasing hypoxia, it is essential that one oxygenates the patient. Cricothyroidotomy provides an opening in the pace between the anterior inferior border of the thyroid cartilage and the anterior superior border of the cricoid cartilage, allowing access to the airway below the glottis. The anatomical considerations are important when performing this procedure (Ellis, 2009), and there are other scenarios when it is used. It is not without consequence, as with any procedure.

Simulation-based training bundle significantly reduces time to oxygen delivery via needle cricothyroidotomy in airway emergency

“…Needle cricothyroidotomy is a simple but potentially life-saving emergency airway manoeuvre used to provide oxygenation during a ‘cannot intubate, cannot ventilate’ (CICV) emergency 1 2. The procedure involves inserting a large bore cannula through the cricothyroid membrane and can be performed in patients of all ages 3.…”

“…The procedure involves inserting a large bore cannula through the cricothyroid membrane and can be performed in patients of all ages 3. It is, however, only a short-term oxygenation solution prior to insertion of a definitive airway 1. The procedure is taught on Advanced Paediatric Life Support (APLS) courses where focus is on needle cricothyroidotomy insertion and not subsequent airway utilisation 3.…”