Page 193 - 2023 SMOG Digital

NEEDLE CRICOTHYROIDOTOMY

CLINICAL INDICATIONS:
• Child <10yo in whom open cricothyroidotomy is contraindicated with the following:
o Failed intubation attempts x 3 by the most experienced provider present with inability to ventilate
with BVM/high risk to ventilate with BVM.
o Inability to place/ventilate with blind insertion airway device (BIAD).
o Massive facial trauma or neck trauma precluding the use of orotracheal intubation/BIAD.
CONTRAINDICATIONS:
• Ability to ventilate adequately with BVM.
• Prolonged time to definitive care (relative).
NOTE: this technique requires a minimum of 50 psi O2 or pressurized air flow and a special adapter to
connect the line to the catheter hub; do not attempt otherwise.
PROCEDURE:
• Maintain patient in sniffing position or place them into sniffing position. Utilize inline stabilization if indicated.
• Oxygenate the patient with 100% O2. Identify and cleanse the cricoid area with betadine / alcohol while
oxygenating if possible.
• Using a 14g IV attached to a 3mL syringe, puncture the cricothyroid membrane at a 90º angle. Do not
advance needle once air returned.
c
• Change angle to 45º and advance catheter only. Should advance with no resistance. Remove needle and
syringe.
• Secure catheter in place. Remove needle and plunger from syringe and place an adapter from a 7-0ETT on
end of syringe in place of plunger. Attach this to the catheter.
• Attach a BVM attached to 100% O2 to the adapter / syringe and ventilate. A large amount of 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.

193