Surgical Cricothyrotomy (Assist)
PREREQUISITE NURSING KNOWLEDGE
• Surgical cricothyrotomy is used only when the airway cannot be obtained or maintained by standard means such as self-inflating manual resuscitation bag-valve-mask device, the use of airway adjuncts (oropharyngeal or nasopharyngeal airways), endotracheal intubation, or rescue airway (Combitube, laryngeal mask airway [LMA], or King Airway).3,4
• Surgical cricothyrotomy may be needed in patients with facial or neck trauma. Maintenance of the airway may be difficult in these patients because the injuries often disrupt the lower facial structures and make an adequate seal with a self-inflating manual resuscitation bag-valve-mask device difficult to obtain. The airway may also be obstructed or disrupted making endotracheal intubation difficult or ineffective.
• Difficulty in obtaining or maintaining an airway may result from upper airway obstruction as a result of trauma, allergic reactions with swelling and angioedema, foreign bodies, anatomic variations, and bleeding.2
• The need for emergent surgical cricothyrotomy must be determined quickly. This intervention is potentially life-saving, and implementation cannot be delayed.
• Surgical cricothyrotomy requires specialized training and should be performed only by highly skilled medical providers.2
• Commercially prepared cricothyrotomy kits are available and often use a modified Seldinger technique with a guidewire or dilator system.
Contraindications
Relative
In young children, the airway is funnel-shaped with the narrowest portion at the cricoid ring rather than the vocal cords as in adults. This narrowing increases the risk of development of subglottic stenosis after cricothyrotomy. Percutaneous transtracheal ventilation via needle cricothyrotomy is the method of choice for surgical airway management in young children.6
EQUIPMENT
• Personal protective equipment (face mask, eye protection, gown, sterile gloves)
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