A cricothyrotomy is a type of emergency airway puncture technique. It has many names, and is also known as a cricothyroidotomy, a thyrocricotomy, a coniotomy or an inferior laryngotomy. The procedure involves making a cut in what is known as the cricothyroid membrane, which is situated underneath the thyroid cartilage, or Adam's apple, and inserting a tube through the incision. Cricothyrotomy may be carried out when there is a blockage higher up in the airway which is causing choking and preventing breathing. In a life-threatening situation, a trained medical professional can use the technique to enable air to reach the lungs, keeping the person alive until admission to the hospital is possible.
Emergency medical procedures become necessary when a person is unable to breathe unaided and, if it is not possible to pass a tube through the mouth or nose down into the windpipe, or trachea, a cricothyrotomy may be carried out. It has the advantage of being a relatively quick and simple operation. Another technique, known as tracheostomy, where an opening is cut into the trachea, or windpipe, is more difficult to perform and is associated with a greater number of complications. These types of surgical procedures are usually performed in life or death situations when there is no other option, and should be carried out by experienced practitioners.
A cricothyrotomy may be required if the airway becomes blocked. Blockage could be caused by a piece of food, bone fragments or teeth following serious injury to the head and neck, or swelling caused by an allergic reaction. The procedure may also be necessary in cases where the teeth are clenched shut or the area around the mouth is badly burned, making it impossible to pass a normal breathing tube down into the trachea.
Different types of cricothyrotomy may be carried out. What is known as a needle cricothyrotomy involves the use of a needle with a tube called a cannula around it. The needle is used to pierce the cricothyroid membrane, then the cannula is inserted into the trachea and the needle is withdrawn. An oxygen supply can be connected to the cannula for around 45 minutes, which may be long enough to allow admission to a hospital. It is not possible to use the technique for a longer period because it does not allow carbon dioxide to leave the blood efficiently, resulting in potentially harmful levels building up.
A surgical cricothyrotomy involves the use of a scalpel to make a larger incision in the cricothyroid membrane, into which a tube is inserted. The tube may be used to ventilate the person for as long as 24 hours. Following a cricothyrotomy, most patients survive long enough to reach the hospital, although subsequent survival depends upon the severity of their underlying conditions.