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Needle Cricothyroidotomy

last modified on: Fri, 01/05/2024 - 15:23

Needle cricothyroidotomy[1|http://wiki.uiowa.edu/#_ftn1]  
This bag is in the University of Iowa ENT ER cart. This could potentially serve as a bridge for oxygenating a patient with a lost airway while you take him to the OR for a trach or while you are setting up for an emergent trach in the ER/ICUs, especially when you're dealing with a pediatric patient.
Dr. Scamman with anesthesia was a big help with getting this together.
 

It includes:
1.18G needle (apparently trying to ventilate through an angiocatheter is difficult since it tends to kink)
2. End of a 3.0 endotracheal tube that fits on the needle hub and you can push oxygen through.
3. Extension catheter should you have a short thick neck that precludes direct insertion of the bagging device onto the needle.   
You need one other thing that you should ask for is a syringe half-filled with saline to use for confirmation of insertion of the needle into the airway (bubbles on aspiration). 
The end of the 3.0 ET fits precisely on the end of the 18G: 

18G with extension tubing in place. 


----[1|http://wiki.uiowa.edu/#_ftnref1] Courtesy of Geir Tryggvason

Editors note (HH): The best way to ventilate a patient depends on many factors. It is good to have the full repertoire of options available - including the needle cricothyroidotomy approach. Support for this method is present in peer-reviewed publications (Bould et al) -- however, in my experience with airway obstruction, I have not had a favorable experience with the needle cricothyroidotomy technique. The few cases in which I tried it (more than 20 years ago) required rapid conversion to an open procedure due to difficulties in ventilating. A comparison of success in establishing an airway without complication (in adult human cadavers by 5th year German medical students) showed that 'anatomical-surgical techniques' were superior to 'puncture techniques' (Schober et al). In contrast, Mace and Khan assert that needle cricothyrotomy is preferred over surgical cricothyrotomy in infants and young children.

The literature emphasizes the need to observe the chest falling in expiration before administering a another jet or bag administered inhalation to avoid barotrauma.  

References

Bould MD and Bearfield P: Techniques for emergency ventilation through a needle cricothyroidotomy. Anaesthesia 2008, 63 pp 535-539

Patrick Schober, Martina C. Hegemann, Lothar A. Schwarte, Stephan A. Loer, and Peter Noetges: Emergency cricothyrotomy - A comparative study of different techniques in human cadavers.  Resuscitation|Volume 80, Issue 2, February 2009, Pages 204-209

Mace SE, Khan N. Needle cricothyrotomy Emerg Med Clin North Am. 2008 Nov;26(4):1085-101,