Page 210 - 2026 SMOG

NEEDLE CRICOTHYROIDOTOMY
Clinical Indications
• Child <10y/o in whom open cricothyroidotomy is contraindicated with the following:
˚ Failed intubation attempts ×3 by the most experienced provider present, with inability to
ventilate with BVM/high risk to ventilate with BVM
˚ Inability to place/ventilate with a blind insertion airway device (BIAD)
˚ Massive facial trauma or neck trauma precluding the use of orotracheal intubation/BIAD
Contraindication:
• Ability to ventilate adequately with BVM
• Prolonged time to definitive care (relative)
**NOTE: this technique requires a minimum of 50psi O or pressurized air flow and a special
2
adapter to connect the line to the catheter hub; do not attempt otherwise.**
Procedure
• Maintain the patient in the sniffing position or place them into the sniffing position. Utilize
inline stabilization if indicated.
• Oxygenate the patient with 100% O . Identify and cleanse the cricoid area with Betadine/
2
alcohol while oxygenating, if possible
• Using a 14G IV attached to a 3ml syringe, puncture the cricothyroid membrane at a 90° angle.
Do not advance needles once air has returned
• Change the angle to 45° and advance the catheter only. Should advance with no resistance.
Remove the needle and syringe
• Secure the catheter in place. Remove the needle and plunger from the syringe and place
an adapter from a 7-0 ETT on the end of the syringe in place of the plunger. Attach this to
the catheter
• Attach a BVM attached to 100% O to the adapter/syringe and ventilate. A large amount of
2
resistance will be felt due to the small catheter size. Evaluate for chest rise and oxygenation.
The provider needs to allow a 1:3 ratio of inhalation/exhalation
**Document procedure, results, and vital signs**
**NOTE: Needle Cricothyroidotomy only allows for oxygenation, not ventilation. It is meant
as a temporizing measure until definitive care—tracheostomy—can be performed at an MTF.
This airway should be used for only 20–30min maximum if able.
• Start working alternatives immediately after initiation—such as retrograde wire intubation,
surgical cric with needle as an anatomical landmark.**

202 • PROCEDURES