From the Guidelines
An emergency cricothyrotomy tube can be kept in place for a short period, typically 24-72 hours, but it should be replaced with a more permanent airway solution as soon as possible to minimize complications and ensure optimal ventilation. The emergency cricothyrotomy tube is a temporary measure designed for immediate life-saving airway access, usually a small-diameter tube (around 6 mm internal diameter) inserted through an incision in the cricothyroid membrane 1.
To maintain the tube, it is essential to:
- Secure it firmly to prevent dislodgement
- Provide humidified oxygen to prevent mucus plugging
- Suction as needed to keep the airway clear
- Monitor for complications like bleeding or subcutaneous emphysema
The tube should be replaced with either a tracheostomy or endotracheal intubation within 24-72 hours because it has a high risk of complications if left long-term, provides suboptimal ventilation due to its small diameter, and the cricothyroid space can become damaged with prolonged use 1. Remember, this is an emergency intervention, and definitive airway management should be arranged as soon as the patient is stabilized.
In the context of critically ill adults, the optimal technique for front-of-neck airway (FONA) management is via the cricothyroid membrane using an open 'surgical' approach (scalpel cricothyroidotomy), which is a fast and reliable technique with a high success rate 1. High-pressure source transtracheal ventilation via a narrow-bore cannula, also known as transtracheal jet ventilation (TTJV), is not recommended due to its high risk of failure and complications 1.
Therefore, it is crucial to prioritize the replacement of the emergency cricothyrotomy tube with a more permanent airway solution to ensure the best possible outcomes in terms of morbidity, mortality, and quality of life.
From the Research
Cricothyrotomy Tube Usage
- A cricothyrotomy tube can be used as a temporary measure for airway management, but its prolonged use is a subject of controversy 2
- The incidence of short-term complications from cricothyrotomy ranges from zero to 31.6%, while long-term complications range from zero to 7.86% 2
- Subglotic stenosis is a reported long-term complication, although it is quite infrequent, occurring in 2.9 to 5% of cases 2
Conversion to Tracheostomy
- The frequency of conversion to tracheostomy after cricothyrotomy varies from zero to 100% 2
- Some studies suggest that cricothyrotomy can be used as a definitive airway, but the level of evidence is low and does not support routine use 2
- In some cases, cricothyrotomy may need to be converted to tracheostomy due to complications or inadequate ventilation 3
Feasibility and Safety
- Cricothyrotomy can be a fast and safe method for emergency airway management, especially in cases where conventional tracheotomy is not feasible 4
- Improvised cricothyrotomy devices can provide reliable airway access in emergency situations, even in unembalmed human cadaver models 5
- Cricothyrotomy can be successfully performed even after thrombolytic therapy, although bleeding may be a concern 6