Needle Cricothyrotomy

Indications: airway obstruction where oral (including LMA, King, Combitube, etc.) or nasal intubation unsuccessful

• Locate landmarks: cricothyroid membrane, just below thyroid cartilage (Adam's apple)
• Prepare insertion site with antiseptic
• Attach over-the-needle catheter to 3 mL syringe
• Adults: 10 g–14 g, 3½" over-the-needle catheter
• Children <12 years: 14 g, 1¾" over-the-needle catheter
• Stabilize larynx, and insert needle at 45° angle in a downward direction along midline (toward carina)
• Maintain negative pressure on syringe during insertion
• Advance catheter, and discard needle after successfully entering trachea (confirmed by aspiration of air)
• Reconnect 3 mL syringe (discard plunger) to inserted 14 gauge catheter, then connect syringe to BVM using a 7.5 mm ET tube adapter (see following illustrations for setup)
• Ventilate Pt for 1 second
• Allow Pt to exhale for 4 seconds