Equipment and strategies for emergency tracheal access in the adult patient

Anaesthesia. 2011 Dec;66 Suppl 2:65-80. doi: 10.1111/j.1365-2044.2011.06936.x.


The inability to maintain oxygenation by non-invasive means is one of the most pressing emergencies in anaesthesia and emergency care. To prevent hypoxic brain damage and death in a 'cannot intubate, cannot oxygenate' situation, emergency percutaneous airway access must be performed immediately. Even though this emergency is rare, every anaesthetist should be capable of performing an emergency percutaneous airway as the situation may arise unexpectedly. Clear knowledge of the anatomy and the insertion technique, and repeated skill training are essential to ensure completion of this procedure rapidly and successfully. Various techniques have been described for emergency oxygenation and several commercial emergency cricothyroidotomy sets are available. There is, however, no consensus on the best technique or device. As each has its limitations, it is recommended that all anaesthetists are skilled in more than one technique of emergency percutaneous airway. Avoiding delay in initiating rescue techniques is at least as important as choice of device in determining outcome.

Publication types

  • Review

MeSH terms

  • Airway Management / instrumentation*
  • Airway Management / methods*
  • Anesthesiology / education
  • Cricoid Cartilage / surgery
  • Emergency Medical Services
  • Humans
  • Intubation, Intratracheal / methods*
  • Operating Rooms / organization & administration
  • Oxygen Inhalation Therapy
  • Patient Care Management
  • Patient Care Planning
  • Risk Reduction Behavior
  • Thyroidectomy / adverse effects
  • Thyroidectomy / instrumentation
  • Trachea / physiology*
  • Tracheostomy / adverse effects
  • Tracheostomy / instrumentation
  • Treatment Failure