NEEDLE CRICOTHYROTOMY


Surgical airway of choice in children <10 years old. Allows for oxygenation, but ventilation is often inadequate.
 
INDICATIONS
  • Rescue device for oxygenation in failed airway

CONTRAINDICATION
  • Tracheal transection with retraction of the distal end
  • Cricoid or laryngeal damage

PROCEDURE
  • Attach a 12- or 14-gauge needle catheter to a 3-mL syringe.
  • Locate and stabilize the cricoid membrane.
  • Direct the needle catheter inferiorly and insert it (aspirating continuously) through the cricoid membrane into the trachea.
  • Once in trachea, advance the catheter over the needle.
  • Attach catheter to jet-ventilation system and oxygenate.
  • Deliver 100% O2 for 1 second, then release for 4 seconds and repeat.

COMPLICATIONS
  • Common
    ■ Subcutaneous emphysema, catheter kinking/obstruction, coughing if patient is conscious, CO2 retention
     
  • Uncommon but serious
    ■ Barotrauma, pneumothorax, pneumomediastinum