Needle Cricothyroidotomy

Emergency surgical airways are often difficult to establish in children and have high complication rates. Hence, needle cricothyroidotomy has been advocated as the preferred airway access technique in the pediatric population. Needle cricothyroidotomy is performed by first identifying the cricothyroid membrane. A large-bore (14-gauge) intravenous catheter is passed through the membrane into the airway at a 45-degree caudad angle. The needle is removed, and an adapter is placed on the catheter so a standard bag-valve mask can be connected for oxygenation. This system has been shown to provide adequate oxygenation for prolonged periods of time. It cannot, however, provide adequate ventilation.13

Transtracheal jet ventilation allows ventilation and oxygenation through a catheter. Ventilation is provided with short, intermittent bursts of oxygen. This requires high-pressure (50 psi) oxygen-delivery systems. The system of choice is a jet injector regulated by a flow meter attached to a wall or tank unit. The less optimal choice is an unregulated wall or tank system. A 1-s jet of oxygen followed by a 4-s expiratory phase achieves satisfactory ventilation. 14

Complications of needle cricothyroidotomy include bleeding, infection, esophageal perforation, breakage or bending of the needle, subcutaneous emphysema, pneumothorax, pneumomediastinum, and pneumopericardium.

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