Anatomy for Emergency Medicine 007: Cricothyroidotomy

23 Feb

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As mentioned in the video here are some of the cric resources out there on the interweb

Minh Le Cong on EMCrit and twitter

Needle v Knife on EMCrit

Video of cric by Scott on vimeo, and another

The Ultrasound Podcast on US guided cric

HQMEDED on Vimeo

And the collection to rule them all on LITFL


You want more?

This is a nice review of the clinical anatomy:

Boon JM, Abrahams PH, Meiring JH, Welch T. Cricothyroidotomy: a clinical anatomy review. Clin. Anat. 2004 Sep.;17(6):478–486. PMID 15300867

And here’s my list of cric papers:

1. Leibovici D, Fredman B, Gofrit ON, Shemer J, Blumenfeld A, Shapira SC. Prehospital cricothyroidotomy by physicians. American Journal of Emergency Medicine. 1997 Jan.;15(1):91–93.

2. Paix B. Emergency surgical cricothyroidotomy: 24 successful cases leading to a simple “scalpel–finger–tube” method – Paix – 2011 – Emergency Medicine Australasia – Wiley Online Library. Emergency Medicine Australasia.

3. Navsa N, Tossel G, Boon JM. Dimensions of the neonatal cricothyroid membrane – how feasible is a surgical cricothyroidotomy? Paediatr Anaesth. 2005 May;15(5):402–406.

4. Chan TC, Vilke GM, Bramwell KJ, Davis DP, Hamilton RS, Rosen P. Comparison of wire-guided cricothyrotomy versus standard surgical cricothyrotomy technique. JEM. 1999 Oct.;17(6):957–962.

5. Morris A, Lockey D, Coats T. Fat necks: modification of a standard surgical airway protocol in the pre-hospital environmental. Resuscitation. 1997 Nov.;35(3):253–254.

6. MacIntyre A, Markarian MK, Carrison D, Coates J, Kuhls D, Fildes JJ. Three-step emergency cricothyroidotomy. Mil Med. 2007 Dec.;172(12):1228–1230.

7. Price RJ, Laird C. A survey of surgical airway experiences and equipment among immediate care doctors. Emergency Medicine Journal. 2009 Jun.;26(6):438–441.

8. Schiri pour Tscharlou A, Klappenberger J, Klappenberger S, Firbas W. A new device for cricothyroidotomy. Clin. Anat. 2006 Oct.;19(7):602–604.

9. Clancy MJ. A study of the performance of cricothyroidotomy on cadavers using the Minitrach II. Arch Emerg Med. 1989 Jun.;6(2):143–145.

10. McGill J, Clinton JE, Ruiz E. Cricothyrotomy in the emergency department. Ann Emerg Med. 1982 Jul.;11(7):361–364.

11. Eisenburger P, Laczika K, List M, Wilfing A, Losert H, Hofbauer R, et al. Comparison of conventional surgical versus Seldinger technique emergency cricothyrotomy performed by inexperienced clinicians. Anesthesiology. 2000 Mar.;92(3):687–690.

12. Schaumann N, Lorenz V, Schellongowski P, Staudinger T, Locker GJ, Burgmann H, et al. Evaluation of Seldinger technique emergency cricothyroidotomy versus standard surgical cricothyroidotomy in 200 cadavers. Anesthesiology. 2005 Jan.;102(1):7–11.

13. Dimitriadis JC, Paoloni R. Emergency cricothyroidotomy: a randomised crossover study of four methods. Anaesthesia. 2008 Nov.;63(11):1204–1208.

14. Elliott DSJ, Baker PA, Scott MR, Birch CW, Thompson JMD. Accuracy of surface landmark identification for cannula cricothyroidotomy. Anaesthesia. 2010 Sep.;65(9):889–894.

15. Platts-Mills TF, Lewin MR, Wells J, Bickler P. Improvised Cricothyrotomy Provides Reliable Airway Access in an Unembalmed Human Cadaver Model. Wilderness and Environmental Medicine. Elsevier; 2006 Jun. 1;17(2):81–86.

16. Metterlein T, Frommer M, Ginzkey C, Becher J, Schuster F, Roewer N, et al. A randomized trial comparing two cuffed emergency cricothyrotomy devices using a wire-guided and a catheter-over-needle technique. JEM. 2011 Sep.;41(3):326–332.

17. Wang HE, Mann NC, Mears G, Jacobson K, Yealy DM. Out-of-hospital airway management in the United States. Resuscitation. 2011 Apr.;82(4):378–385.

18. Boon JM, Abrahams PH, Meiring JH, Welch T. Cricothyroidotomy: a clinical anatomy review. Clin. Anat. 2004 Sep.;17(6):478–486.

19. Benkhadra M, Lenfant F, Nemetz W, Anderhuber F, Feigl G, Fasel J. A comparison of two emergency cricothyroidotomy kits in human cadavers. Anesthesia & Analgesia. 2008 Jan.;106(1):182–5, table of contents.

20. Adams BD, Whitlock WL. Bystander cricothyroidotomy performed with an improvised airway. Mil Med. 2002 Jan.;167(1):76–78.

21. Heard AMB, Green RJ, Eakins P. The formulation and introduction of a “can‘t intubate, can’t ventilate” algorithm into clinical practice. Anaesthesia. 2009 Jun.;64(6):601–608.

22. Davis DP, Bramwell KJ, Hamilton RS, Chan TC, Vilke GM. Safety and efficacy of the Rapid Four-Step Technique for cricothyrotomy using a Bair Claw. JEM. 2000 Aug.;19(2):125–129.

23. Owens D, Greenwood B, Galley A, Tomkinson A, Woolley S. Airflow efficacy of ballpoint pen tubes: a consideration for use in bystander cricothyrotomy. Emergency Medicine Journal. 2010 Apr.;27(4):317–320.

24. Hill C, Reardon R, Joing S, Falvey D, Miner J. 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 Med. 2010 Jun.;17(6):666–669.

25. Reid LA, Dunn M, Mckeown DW, Oglesby AJ. Surgical airway in emergency department intubation. Eur J Emerg Med. 2011 Jun.;18(3):168–171.

26. Warner KJ, Sharar SR, Copass MK, Bulger EM. Prehospital management of the difficult airway: a prospective cohort study. JEM. 2009 Apr.;36(3):257–265.


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