Needle vs surgical cricothyroidotomy: a short cut to effective ventilation

Anaesthesia. 2006 Oct;61(10):962-74. doi: 10.1111/j.1365-2044.2006.04755.x.


Cricothyroidotomy can be performed using three techniques. This literature review seeks to determine which is more appropriate for use in prehospital can't intubate/can't ventilate scenarios where laryngeal mask airways prove ineffective. The common approach of inserting a 14-gauge cannula and using low-pressure ventilation via intermittent occlusion of an opening in oxygen tubing (15 l x min(-1) flow) results in ineffective ventilation within 60 s or less, depending on the degree of airway obstruction. In the absence of a high degree of upper airway obstruction, ventilation can be effective if the cannula is attached to a high pressure (45 psi) jet ventilator, but such devices are rare in UK prehospital practice. A self-inflating bag used with a cuffed tube inserted through a horizontal scalpel incision provides sustained adequate ventilation, has a relatively low complication rate compared to needle cricothyroidotomy and is a skill that can be easily taught to paramedics, nurses and doctors.

Publication types

  • Comparative Study
  • Review

MeSH terms

  • Airway Obstruction / surgery*
  • Animals
  • Emergencies
  • Emergency Medical Services / methods*
  • Humans
  • Laryngeal Cartilages / surgery*
  • Needles
  • Respiration, Artificial / methods*
  • Tracheostomy / methods*