Cricothyrotomy and Cricothyroidotomy Are the Same Procedure
Cricothyrotomy and cricothyroidotomy are identical terms referring to the same emergency airway procedure—an incision through the cricothyroid membrane to establish a surgical airway. 1 The terms are used interchangeably in medical literature and clinical practice. 2
Anatomical Location
The cricothyroid membrane is located between the thyroid cartilage (superiorly) and the cricoid cartilage (inferiorly), measuring approximately 8-12 mm in length and 8-10 mm in width. 3
This membrane sits superior to the thyroid gland and represents the most superficial point of airway access with minimal overlying vascular structures. 1, 4
The cricothyroid muscle and cricothyroid ligament can be dissected without encountering vital anatomical structures, making this the safest location for emergency front-of-neck airway access. 3
Key Distinction: Cricothyrotomy vs. Tracheostomy
The critical anatomical difference is that tracheostomy is performed lower in the neck—through the tracheal rings below the cricoid cartilage, typically between the 2nd and 4th tracheal rings, approximately 1 cm above the suprasternal notch. 5, 2
Anatomical Differences:
Cricothyrotomy accesses the airway through the cricothyroid membrane (between thyroid and cricoid cartilages). 3
Tracheostomy accesses the airway through the tracheal rings (below the cricoid cartilage, through the thyroid isthmus region). 3, 5
The average tracheal length between cricoid cartilage and suprasternal notch is 6.9-8.2 cm, with 11 tracheal cartilages and 10 annular ligaments in this space. 3
Clinical Implications for Emergency Airway Management
In cannot intubate, cannot oxygenate (CICO) situations, surgical cricothyroidotomy using the scalpel-bougie-tube technique is the preferred emergency front-of-neck airway access method. 1, 2 This recommendation is based on:
Cricothyroidotomy is significantly faster than tracheostomy (60-78 seconds vs. longer surgical time, p < 0.0001). 3, 6
Anatomical-surgical cricothyroidotomy techniques achieve 94-100% success rates compared to 71-82% for puncture techniques. 6
Emergency tracheostomy should be avoided in CICO situations due to increased difficulty, longer procedure time, and higher complication rates from deeper dissection through vascular thyroid tissue. 1, 5
Common Pitfall to Avoid
Do not confuse terminology—"cricothyrotomy" and "cricothyroidotomy" mean the same procedure. 2 The confusion arises because both terms appear in literature, but they reference the identical anatomical location (cricothyroid membrane) and identical surgical technique. 1, 3
When rapid hypoxemia with bradycardia develops, proceed immediately to surgical cricothyroidotomy rather than attempting emergency tracheostomy, as the latter requires deeper dissection, takes longer, and carries higher bleeding risk from thyroid vasculature. 1, 3