Page 57 - Journal of Special Operations Medicine - Spring 2014

Figure 6 Sequence of Cric-Knife operation, from left to right: (1) Stabilizing the thyroid with the
nondominant hand and the dominant hand resting on sternum holding the device. Scalpel is oriented to be
horizontal. [A vertical skin incision can also be used before this step, if required]. (2) Horizontal stab incision
(through both skin and membrane, in this instance). (3) The hook has been slid down the handle by the
thumb placed over the knob, advancing the tip of the hook fully into the hole. (4) After the hook has been
freed from the handle (by sliding fully down the handle), the hook is held by the nondominant hand and has
control of the trachea (lifting the inferior aspect of the thyroid cartilage).

1 2 3 4

the mechanism of sliding down the handle channel all References
reduce the need for fine motor control while performing 1. Mabry RL, Edens JW, Pearse L, et al. Fatal airway injuries
the procedure. during Operation Enduring Freedom and Operation Iraqi
Freedom. Prehosp Emerg Care. 2010;14:272–277.
2. Mabry RL, Frankfurt A. An analysis of battlefield cricothy-
Summary
rotomy in Iraq and Afghanistan. J Spec Oper Med. 2012;
The Cric-Key and Cric-Knife combine the basic equip- 12:17–23.
ment needed for an open cricothyrotomy and merge 3. Cook T, Woodall N, Frerk C. NAP4: Report and Findings
them into a more efficient and simpler system. Instead of the 4th National Audit Project of the Royal College of
of relying on a clinician’s surgical skills and fine motor Anaesthetists.
control, the device is designed to facilitate easy transi- 4. Hessert MJ, Bennett BL. Optimizing emergent surgical cri-
tions from incision to tracheal control, and then inser- cothyrotomy for use in austere environments. Wilderness
Environ Med. 2013;24:53–66.
tion of a short, cuffed tube. Combining an introducer 5. Murphy C, Rooney SJ, Maharaj CH, et al. Comparison
with a tube, and the scalpel with the hook, reduces the of three cuffed emergency percutaneous cricothyroidotomy
number of separate instruments to two (as opposed to devices to conventional surgical cricothyroidotomy in a
four for a separate scalpel, hook, bougie, and tube). porcine model. Br J Anaesth. 2011;106:57–64.
Both devices have been specifically designed for crico- 6. Grossman D, Christensen LW. On combat: the psychology
thyrotomy; they are small, lightweight, robust, and in- and physiology of deadly conflict in war and peace. WSG
tuitive, making them ideal for use in tactical and combat Research Publications; 2004.
environments. 7. Braude D, Webb H, Stafford J, et al. The bougie aided cri-
cothyrotomy. Air Med J. 2009;July–August:191–194.
8. Macintosh R. An aid to intubation. Br Med J. 1949;1:28.
Disclosure 9. Mabry RL, Nichols M, Shiner DC, et al. A comparison of
two open surgical cricothyrotomy techniques by military
Dr. Levitan is the president of Airway Cam Technolo- medics using a cadaver model. Ann Emerg Med. 2014;63:
gies, Inc. (Wayne, Pennsylvania), which makes and sells 1–5.
educational products related to airway management.
He invented the Cric-Key and Cric-Knife and receives
royalties on their sale. Both devices are manufactured
by Engineered Medical Systems Inc. (Indianapolis, Indi- Dr. Levitan is adjunct professor in the Department of Medicine,
ana). The devices are sold by Pulmodyne Inc. (Indianap- Division of Emergency Medicine, Dartmouth (Geisel) School of
olis) and Combat Medical Systems, Inc. (Fayettesville, Medicine, Hanover, New Hampshire, and visiting professor,
North Carolina); packaged together, they are labeled the Emergency Medicine, University of Maryland Medical Center,
Control-Cric™ system. Baltimore, Maryland. E-mail: airwaycam@gmail.com.

Cric-Key and Cric-Knife : Combined Open Cricothyrotomy System 49
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