The Surgical Airway

If an airway cannot be obtained by any other means, then surgical access to the trachea must be obtained. Emergency tracheostomy is difficult and time-consuming and is, therefore, not indicated. Several other techniques have been advocated for use in CPR; all provide access through the cricothyroid membrane and all carry risk of misplacement and haemorrhage. Needle cricothyroidotomy is the technique of choice as it is least difficult to perform. In this technique a 14 G intravenous cannula is directed caudally through the cricothyroid membrane. If equipment is available, percutaneous transtracheal jet ventilation can be used. In an emergency a length of oxygen tubing with a side hole which can be intermittently occluded can be used to provide temporary ventilation. Surgical cricothyroidotomy and blind stab techniques are more difficult and percutaneous dilatational tracheostomy is too time consuming in an emergency. Whichever technique is used to access the trachea, correct placement must be confirmed.

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