Emergency cricothyrotomy: A procedure well worth knowing.

Abstract

There are two possible approaches to the subglottic airway: tracheotomy, and cricothyroidotomy. Cricothyroidotomy is less well known by head and neck surgeons and has a bad reputation due to laryngeal morbidity, liable to progress to subglottic stenosis if not swiftly relayed by tracheotomy. Tracheotomy is taught early on in ENT training, notably to be performed under enhanced local anesthesia in patients with tumoral laryngeal dyspnea. It is, however, completely unsuited to other emergency situations, in patients that cannot be ventilated or in case of failure of orotracheal intubation, notably due to anatomic factors. Cricothyroidotomy is the attitude of choice in this extremity. In certain hazardous wartime situations, where orotracheal intubation is contraindicated for operational reasons and issues of capacity with collective impact, "tactical" cricothyroidotomy can be chosen in first line in an awake patient under mild sedation. The French Army Health Service ENT physicians are therefore trained in cricothyroidotomy. We here present our procedural technique, with indications and contraindications in first line in civilian emergency situations of infection, trauma, tumor, allergy and/or edema.