Quick overview of the surgical cricothyroidotomy technique as presented in the 2015 Difficult Airway Society guidelines. This is simply presenting the technique in a manikin model, not intended as a debate about the relative merits of needle vs. surgical, blade vs. hook, scalpel-finger-bougie vs. scalpel-bougie-tube, etc!
Don’t forget to wear your PPE (gloves, mask, eye protection) and appropriately secure the tube afterwards.
As always, constructive criticism and suggestions for improvement are always welcomed in the comments section.
Technique for using the Aintree Intubating Catheter (AIC) to exchange between a supraglottic airway (SGA) and endotracheal tube (ETT). This is typically required when an airway has been ‘rescued’ with an SGA that is not designed for direct intubation, with a narrow internal diameter or obstructions. The Aintree has a length of 55cm, internal diameter of 4.8 mm (not 4.2 as stated in the video) and external diameter of 6.0 mm, allowing a paediatric fibrescope or flexible intubating vide endoscope (preferably 4 mm or less) to be passed through the AIC, into the trachea, and then an ETT railroaded after removal of the SGA over the AIC. If that sounds confusing, watch the video!
Tips/tricks/advice/critique? Leave a comment!
The Difficult Airway Society (DAS) have a nice poster guide to help you remember how to do this – click the image below to open/download. (Open access).
A description of the technique for intubating through a supraglottic airway that offers a sufficiently large internal bore to allow an appropriate-sized endotracheal tube using an adult fibreoptic or flexible video endoscope. Take note of the method of providing ventilation during the endoscopy!
As usual, this is an unscripted video, and constructive critique is welcomed to help us improve the educational offering.
Lots of ensuing discussion of the ideal angle of puncture of the cricothyroid membrane. 90 degrees (perpendicular to skin) has least risk of puncturing posterior wall of the trachea, but greatest risk of cannula kinking. I advocate around 60 degrees for puncture and then decreasing angle to advance cannula:
Open access meducation for all aspects of airway management