Knowing when to perform cricothyrotomy

In this short Medmastery Clinical guide article, learn how to recognize the indications for a circothyrotomy procedure.
Last update19th Nov 2020

Cricothyrotomy is the way to definitively secure the airway of a dying patient (who can't be intubated or ventilated) by cutting a hole through the neck and placing a breathing tube directly into the bronchus.

Figure 1. Cricothyrotomy requires cutting a hole through the neck and placing a breathing tube directly into the bronchus.

Indications for cricothyrotomy

There are four indications for the cricothyrotomy procedure:

  1. Upper airway obstruction
  2. Laryngeal spasm
  3. Trismus
  4. Trauma
Figure 2. Indications for the cricothyrotomy procedure include obstruction of upper airway, laryngeal spasm, trismus, and trauma.

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Contraindications for cricothyrotomy

There are three important contraindications for the cricothyrotomy procedure:

  1. There is an alternative and less invasive way to secure the airway.
  2. Your patient is younger than eight years old (underdeveloped cricothyroid membrane).
  3. The obstruction is below the cricothyroid membrane.
Figure 3. Contraindications for the cricothyrotomy procedure include availability of an alternative and less invasive procedure, patient younger than eight years old, and obstructions below the cricothyroid membrane.

Consent for cricothyrotomy

Consent is not possible for cricothyrotomy unless you anticipate a difficult airway before a patient is paralyzed for intubation.

In general, you’ll only be performing this heroic procedure if the patient is already dying. If you’re performing a cricothyrotomy, you’ve already determined there is no other alternative, and if you don’t perform the procedure, your patient will die.

That’s it for now. If you want to improve your understanding of key concepts in medicine, and improve your clinical skills, make sure to register for a free trial account, which will give you access to free videos and downloads. We’ll help you make the right decisions for yourself and your patients.

Recommended reading

  • Hill, C, Reardon, R, Joing, S, et al. 2010. Cricothyrotomy technique using gum elastic bougie is faster than standard technique: a study of emergency medicine residents and medical students in an animal lab. Acad Emerg Med17: 666–669. PMID: 20491685
  • MacIntyre, A, Markarian, MK, Carrison, D, et al. 2007. Three-step emergency cricothyroidotomy. Mil Med172: 1228–1230. PMID: 18274018
  • Quick, JA, MacIntyre, AD, and Barnes, SL. 2014. Emergent surgical airway: comparison of the three-step method and conventional cricothyroidotomy utilizing high-fidelity simulation. J Emerg Med46: 304–307. PMID: 24188608

About the author

Siamak Moayedi, MD
Professor and Director of Medical Student Education, University of Maryland and Course Director, Essential and Critical Procedures, Emergency Medicine.
Author Profile
ACCME accredited, UEMS accredited, Comenius EduMedia Siegel 2017, BMA Highly recommended