Cricothyroidotomy

Abstract

When a hospitalized patient requires the establishment of an airway in the upper respiratory tract under emergency conditions, the first priority is to achieve endotracheal intubation, generally through the mouth, with a laryngoscope. In situations where endotracheal intubation cannot be established with great rapidity, an immediate cricothyroidotomy or tracheotomy is indicated. Of these two procedures, we agree with Boyd, Romita, Conlan, Fink, and associates that cricothyroidotomy has many advantages over tracheotomy under emergency conditions. The cricothyroid membrane is situated directly under the skin with no intervening tissues, such as muscle and the thyroid isthmus, which are encountered during tracheotomy. Cricothyroidotomy is easily learned and can be performed very rapidly with minimal risk. It involves an incision in the membrane between the lower border of the thyroid cartilage and the cricoid cartilage for purposes of tracheal intubation. Utilized under proper conditions, it has been demonstrated to be safe in a series of 655 cases reported by Brantigan and Grow (1976) and in another series of 147 cases reported by Boyd and associates.