Bedside sonography by emergency physicians for the rapid identification of landmarks relevant to cricothyrotomy

Am J Emerg Med. 2008 Oct;26(8):852-6. doi: 10.1016/j.ajem.2007.11.022.


Introduction: Cricothyrotomy is a difficult, infrequently performed lifesaving procedure.

Objectives: The objectives of the study were to develop a standardized ultrasound technique to sonographically identify the cricothyroid membrane (CM) and to evaluate the ability of emergencyphysicians (EPs) to apply the technique in a cohort of Emergency Department (ED) patients.

Methods: Four cadaveric models were used to develop a technique to accurately identify the CM. Two EPs then sonographically imaged 50 living subjects. Time to visualization of the CM and relevant landmarks, as well as perception of landmark palpation difficulty, were recorded.

Results: Fifty subjects were enrolled, and relevant structures were identified in all participants. The mean time to visualization of the CM was 24.32 +/- 20.18 seconds (95% confidence interval, 18.59-30.05 seconds). Although a significant relationship between palpation difficulty and body mass index was noted, body mass index did not impact physician ability to identify the CM.

Conclusions: Emergency physicians were able to develop and implement a reliable sonographic technique for the identification of anatomy relevant to performing an emergent cricothyrotomy.

MeSH terms

  • Adult
  • Airway Obstruction / surgery
  • Body Mass Index
  • Cadaver
  • Confidence Intervals
  • Cricoid Cartilage / diagnostic imaging*
  • Cricoid Cartilage / surgery
  • Emergencies
  • Female
  • Humans
  • Male
  • Middle Aged
  • Palpation
  • Point-of-Care Systems
  • Prospective Studies
  • Thyroid Cartilage / diagnostic imaging*
  • Thyroid Cartilage / surgery
  • Ultrasonography / instrumentation
  • Ultrasonography / methods*
  • Ultrasonography / standards