Observational Cadaveric Study of Emergency Bystander Cricothyroidotomy With a Ballpoint Pen by Untrained Junior Doctors and Medical Students

Emerg Med J. 2013 Apr;30(4):308-11. doi: 10.1136/emermed-2012-201317. Epub 2012 May 5.


Objective: Apart from case reports and anecdotes, there are no published studies on the feasibility of using non-medical devices for emergency bystander cricothyroidotomy. This study evaluated the ability of non-trained junior doctors and medical students to place an emergency cricothyroidotomy on an embalmed cadaver using only a blade and a ballpoint pen.

Methods: Participants were junior doctors with no prior experience of surgical airways and second year medical students at the end of their head and neck anatomy course. Nine participants were asked to place an emergency cricothyroidotomy in an undissected embalmed cadaver using only a No 26 scalpel and a dismantled ballpoint pen (Papermate Flexigrip Ultra, external diameter 8.9 mm; internal diameter 7.0 mm). Times were recorded and direct visualisation by dissection was used to assess placement and complications.

Results: Nine participants performed a total of 14 separate cricothyroidtomies on separate cadavers. Landmarks were palpable by researchers in 10 of the 14 cadavers. Eight of 14 (57%) procedures were deemed successful. No major vascular injury occurred. Injuries to the thyroid and cricoid cartilages were common; four of 14 (29%) of these injuries were fractures.

Conclusions: In embalmed cadavers, inexperienced junior doctors and medical students with no prior training were able to place a successful cricothyroidotomy slightly more than half the time. It suggests that surgical cricothyroidotomy with a ballpoint pen and blade is a feasible option in extremis. It is unknown whether junior doctors from other specialties, such as emergency medicine, would perform better.

MeSH terms

  • Aged
  • Aged, 80 and over
  • Airway Obstruction / surgery*
  • Cadaver
  • Cricoid Cartilage / surgery*
  • Education, Medical, Graduate
  • Emergency Medicine / methods
  • Feasibility Studies
  • Female
  • Humans
  • Larynx / surgery*
  • Male
  • Medical Staff, Hospital
  • Otorhinolaryngologic Surgical Procedures / instrumentation*
  • Surgical Instruments*
  • Thyroid Cartilage / surgery*