Lots of debates in this field! Here are two techniques of surgical/front-of-neck airway access in quick video review:
Surgical Cricothyroidotomy (DAS 2015 Technique)
More techniques and tricks to follow!
If you want perspective on the debate between needle and scalpel as first approach to FONA in a CICO situation, here is some good reading on the subject:
- Why you should consider a needle first: Timmermann A, Chrimes N, Hagberg CA. Need to consider human factors when determining first-line technique for emergency front-of-neck access. British Journal of Anaesthesia. 2016. DOI: 10.1093/bja/aew107
- Never send a needle to do a blade’s work: Baker PA, O’Sullivan EP, Kristensen MS, Lockey D. The great airway debate: is the scalpel mightier than the cannula? British Journal of Anaesthesia 2016; 117 (suppl_1): i17-i19. doi: 10.1093/bja/aew219
- Don’t fool yourself: we’re all guessing about the right technique and location anyway: Law JA. Deficiencies in locating the cricothyroid membrane by palpation: We can’t and the surgeons can’t, so what now for the emergency surgical airway? Canadian Journal of Anaesthesia 2016;63(7):791-6.
What does the clinical evidence show? A good place to start is with The Airway Collaborations’ “Airway App” data, that crowdsourced FONA cases from around the world (and a leading number from South Africa. See the initial data in Anaesthesia here: Dugggan, Lockhart, Cook, O’Sullivan, Dare Baker. The Airway App: Exploring the role of smartphone technology in capturing emeregency front-of-neck airway experiences internationally. Anaesthesia, 2018;73:674-8