cricothyrotomie

Cricothyrotomy, known as cricothyrotomie in French, is an emergency surgical airway established to rapidly ventilate a patient when airway obstruction or failed access to the airway prevents adequate oxygenation and conventional methods are unsuccessful or impractical. The procedure creates a direct airway through the cricothyroid membrane and allows placement of a tube to secure ventilation.

Indications include situations in which endotracheal intubation cannot be performed or fails to provide ventilation (cannot intubate, cannot oxygenate), acute airway obstruction from trauma, burns, edema, anaphylaxis, facial or neck hemorrhage, or severe facial trauma where other airway devices are not feasible.

There are two main approaches: surgical cricothyrotomy and percutaneous cricothyrotomy. In the surgical technique, a skin incision is made over the cricothyroid membrane, the membrane is incised or punctured, and a tube is inserted to establish an airway, often with direct visualization. In the percutaneous approach, a needle or small cannula is placed through the cricothyroid membrane, followed by sequential dilation and the placement of a cannula or endotracheal tube over a guidewire. Both aim to secure a rapid, patent airway, after which definitive airway management is pursued.

Complications can include misplacement into the esophagus, bleeding, injury to the larynx or surrounding structures, pneumothorax or subcutaneous emphysema, tube dislodgement, airway obstruction, and infection. In pediatric patients, anatomical considerations make cricothyrotomy more complex; alternative approaches such as transtracheal ventilation or surgical tracheostomy may be considered depending on the clinical context.