Pediatric Needle Cricothyroidotomy

Pediatric Needle Cricothyroidotomy

Supplies

(Kit located in 2nd Drawer of Pediatric Grey Trauma Cart—Trauma Bay 2)

16G Angiocath (IV catheter)

Macrobore IV Extension Tubing

End of a 3.0 ETT

10 ml Syringe with 5ml saline (for air placement confirmation)

Process for Cannot Intubate and Cannot Ventilate (CICV) Emergency

Video available here: https://youtu.be/EEqXqiOyKr4?si=iF8VRp-n3FwuVeIB

Identify landmarks and stabilize the larynx with non-dominant hand

Access the cricothyroidotomy membrane with a 16G angiocath, aim in the caudad direction

Connect syringe with saline and pull-back to confirm placement by air aspiration

If placement is confirmed, connect macrobore tubing to catheter and then place 3.0 ETT end on tubing (See picture).

Connect to a pressure limiting bag or a jet ventilation device

Breaths should be delivered over 1 second and allowing for 2 second exhalation

Observe for complications such as: subcutaneous emphysema, hemorrhage, hypoventilation, equipment failure, catheter kink, & false placement.

Additional Resources:

 https://www.paediatricemergencies.com/intubationcourse/course-manual/cricothyroidotomy/

https://medicine.uiowa.edu/iowaprotocols/needle-cricothyroidotomy

Please contact Dr. Emily Cantrell, Pediatric Trauma Medical Director, or Lora Hofstetter, Pediatric Trauma Program Coordinator for questions and additional training.