Cite this post as:
Scott Weingart, MD FCCM. EMCrit Podcast 131 – Cricothyrotomy – Cut to Air: Emergency Surgical Airway. EMCrit Blog. Published on August 26, 2014. Accessed on May 19th 2022. Available at [https://emcrit.org/emcrit/surgical-airway/ ].
Financial Disclosures:
Dr. Scott Weingart, Course Director, reports no relevant financial relationships with ineligible companies.
This episode’s speaker(s), (listed above), report no relevant financial relationships with ineligible companies.
CME Review
Original Release: August 26, 2014
Date of Most Recent Review: Jan 1, 2022
Termination Date: Jan 1, 2025
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Do you still use a tracheostomy tube if available? I’ve only used ET tubes for crics, mainly due to availability and also being more flexible. I once tried to replace a regular trach over a bougie and found the rigidity made it difficult. On the other hand it can be challenging to secure an ETT in a cric and they easily migrate into the mainstem. Has anyone tried using a soft silicone trach tube over a bougie?
6-0 portex works beautifully and the ability to secure is much better than ETT
I recorded a real life surgical airway from the TV show Inside Combat Rescue (NATGEO). I use that video on my classes.
If you want me to send you the video email me to Sebastian@mayanz.cl
Scott, Great episode- it’s great that we are embracing the fact that performing a surgical airway isn’t a failure and sometimes it should be the primary technique. You mentioned in the updated CriCon that you only mark the neck and have the cric kit at bedside for the anticipated “risky” airways. Why not mark the neck and have the cric kit within arm’s reach for all airways? I started routinely marking the neck on every airway and I have gotten feedback from the other docs and nursing staff that they like this approach. They have seen too many airways go… Read more »
Steve,
got no problem with that–but if you feel the neck, have the kit in the room, and announce the end of the airway plan is cric, that seems enough for most situations. if you want to mark everyone, i say go for it.
Hi Scott,
Thanks for a fantastic talk. I completely agree that just by picking up a laryngoscope you are commiting to a cric if need be.
Speaking as someone who’s never done one in anger, is the longitudinal incision necessary? If you can feel the anatomy, why cant you just do the transverse incision to save time and cut down on bleeding (even though as you say, the bleeding it’s self is no big problem). What problem would i create for myself by doing this?
Thanks,
Stuart
Anesthesia/ICU resident, Stockholm, Sweden
we generally advocate to train for how you fight. this seems like a perfectly rational idea now (and it is), however when you have to actually do this you will fall back to how you trained. you should train just one way and do it continuously. hence the lack of an option to diverge based on anatomy.
Great talk, Scott. We use at fast stepwise approach to locate the cricothyroid membrane by US egen we are in CRICON yellow.
http://www.anesthesiologynews.com/download/Ultrasound_ANGAM2013_WM.pdf
We feel this ads substantially to Safety during airway management.
like it! the ultrasound podcast guys did a whole series on this
Scott- awesome talk. Amazing how it doesn’t matter how many times I have heard you speak about a topic, always seem to pick up on new subtle things. Wondering if you have ever personally incorporated u/s into your cric, or at least used it for your cric planning/marking in the morbidly obese pt..?
yes, for awake intubations i scope out the neck with ultrasound first
I like the subtle removal of the glasses. Great talk!
: )
I’m going to ask what may be a very silly question. Once the cric is completed, and the patient recovers from their illness. Does the membrane grow back? Do they do fine without it? Does it require surgical repair by ENT later on.
they do just fine without repair–as it is not done, same for trachs. Not sure how much of the membrane heals if any–can just tell you the skin is closed and it heals well.
Nice podcast.
Andy Neill’s video link here is dead. It has moved to a new link.
Thanks
thanks so much!
Hi Scott. Fantastic as always! For how long do you think is safe to leave the cric before converting it to a tracheostomy?
the idea that it has to come out right away has been debunked by the recent ENT literature. Prob. a few days is fine. Depends on whether you have a long unstable ETT sitcking out of the hole.
You can use a stitch-cutter! I just did a cric´ today. But I have to tell you that I´m not an expert on this because it only was my second “real life cric”. Without discussing the case there are two things i want to point out: 1) You can use a stitch-cutter to do a crick. If you want to stop reading at this point this was the most important part. 2) The roundes shape of the blade was very useful! I used a stitch-cutter this time because in the situation it was the only “surgical knive” availeable in the… Read more »
You can use a stitch-cutter! I just did a cric´ today. At this point I have to tell you that I´m not an expert on this because it only was my second “real life cric”. Without discussing the case there are two things i want to point out: 1) You can use a stitch-cutter to do a crick – it works really well. If you want to stop reading at this point this was the most important part. 2) The roundes shape of the blade was very useful! I used a stitch-cutter this time because in the situation it was… Read more »
Simply awesome videos and talk, and very slick! Two quick questions from a Canadian Anesthesia resident: 1) How big is the risk of cutting yourself on bone when sticking your finger into the cricothyroid membrane? I’ve heard some say that a Trousseau dilator should be used instead and to avoid inserting the finger into the hole because of this risk. 2) What is the chance of a Cric leading to voice problems in the future? Ie. damaging the muscles controlling the vocal cords? Thanks a ton and thanks for all your amazing work, it is hugely valuable for me as… Read more »
Great post. Thank you.
The one thing that I have not seen on any of the videos or heard described is how to secure an endotracheal tube that is used for a cric. Could you please comment on your best practice for this?
circumferential taping is the only way–it is not a good way. it is why i prefer trach tubes. i would try to get these tubes changed out to an ETT from above as soon as possible. I’ll post on how to get that done soon.
Hello Scott!
I attended the SMACC airway pre course in Berlin. Thank you for a very educational course. Now to my question. You had a 3D printed model for the surgical airway and stated that the model would be posted here on your site. I can´t find it. When will it be posted?
Best regards
Jonas Westman
I could not find the video. I did see a live performance video and the slides… it said Video does not exist
Esta muy bueno!! Excelente video