Cricothyrotomy Training Manikins

All TruCorp Surgical Cric Trainers:

The AirSim Child Combo X has accurate anatomy based on CT DICOM data from a 6-year-old.

• Truman Trauma X
• AirSim Combo X
• AirSim Combo Bronchi X
• AirSim Child Combo X
• AirSim Child Combo Bronchi X
• Tru Cric

Needle Cricothyrotomy

Needle cricothyrotomy is a preferred emergency airway technique in children and infants because it’s easier to perform on pediatric anatomy and has less risk of damaging the larynx. ⁴

A needle is used to puncture the cricothyroid membrane (in some cases a small incision may be made first to make it easier to insert the needle).

The needle and an over-the-needle catheter enter the through the lower half of the membrane. The syringe and needle are removed and the catheter provides a temporary secure airway.⁵

The benefit of needle cricothyrotomy is reduced risk of complications if the right location is not correctly identified on the first attempt (compared to misidentification with a scalpel).

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Surgical Cricothyrotomy

Surgical cricothyrotomy, also called open cricothyrotomy, involves making a vertical incision through the skin and identifying the cricothyroid membrane.

The membrane is incised horizontally and opened using a gloved little finger or blunt end of the scalpel, allowing an endotracheal or tracheostomy tube to pass through.⁶

Care must be taken not to cut the cricoid or thyroid cartilage.

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Percutaneous Cricothyrotomy Using Seldinger Technique

The wraparound neck skin can be rotated and used for 15+ incisions when practicing surgical airway techniques.

Percutaneous cricothyrotomy using the Seldinger technique is also called the Melker technique or Melker Seldinger technique. The Seldinger Technique in cricothyrotomy is performed advancing a wire guide through a hollow needle and into the trachea.

The needle is removed and the wire guide is used to guide the insertion of an airway catheter/dilator assembly over the wire and into the trachea.

After the wire guide and dilator are removed, the airway catheter is secured and attached to a ventilator device.

The benefit of this technique is that the guide wire maintains airway access until the catheter is in place.⁷

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Cricothyrotomy vs Tracheostomy

Cricothyrotomy and tracheostomy are both emergency surgical airway techniques used as a last resort in a ‘can’t intubate can’t ventilate’ (CICV) scenario.

A cricothyrotomy pierces the cricothyroid membrane to establish an airway. The cricothyroid membrane is in the larynx (voice box) just below the thyroid cartilage (Adam’s apple) in the front of the neck.

A tracheostomy creates a surgical opening (stoma) in the trachea, typically in an operating room under anesthesia, to provide a temporary or permanent alternative airway.

A cricothyrotomy is generally considered to be less difficult and less risky than a tracheostomy in emergency situations.¹ If long-term breathing assistance is required, a cricothyrotomy will usually be replaced by a tracheostomy.²

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Explore all airway management trainers or contact TruCorp for more information.

Sources:

1. Mayo Clinic. [Tracheostomy] 2018
2. Peep Talving, MD, PhD; Joseph DuBose, MD; Kenji Inaba, MD; et al. Conversion of Emergent Cricothyrotomy to Tracheotomy in Trauma Patients. [JAMA Network] 2010
3. Helman, Anton. Episode 69 Obesity Emergency Management. [Emergency Medicine Cases] 2015
4. Manoj K Mittal, MD, MRCP (UK), FAAP. Needle cricothyrotomy with percutaneous transtracheal ventilation. [UpToDate] 2017
5. Markowitz, Joshua E, MD, RDMS, FACEP. Surgical Airway Techniques Technique. [Medscape] 2018
6. Nickson, Chris. Surgical Cricothyroidotomy. [Life in the Fastlane] 2017
7. Bonz, James W, MD. Percutaneous Cricothyrotomy. [Jove] 2018