Bougie-guided Cricothyrotomy Technique

Cricothyrotomy is a life-saving surgical procedure that everyemergency physician, anesthesiologist, and surgeon shouldbe able to perform. This procedure is rarely needed due toimprovements in other airway techniques and equipment, somost airway providers and surgeons are essentially noviceswhen it comes to performing an emergent cricothyrotomy.Several different cricothyrotomy techniques have beendescribed, and there is no standard method for performingthis procedure. The ideal cricothyrotomy technique shouldbe easy to learn and should utilize widely available airwayequipment. Most cricothyrotomy techniques have not beenstudied, but the rapid four-step technique has been shownto be effective. While teaching the four-step cricothyrotomytechnique in our procedure laboratory, and using it in clini-cal practice for the past several years, we noticed that thelimiting step is usually insertion of the Shiley tracheal tube.Video Clip S1 (available as supporting information in theonline version of this paper) shows a novel cricothyrotomytechnique using an airway bougie and a standard endotra-cheal tube, instead of a Shiley tracheal tube. This technique

is easy for novices to learn, utilizes standard equipment, andhas been successfully used in clinical practice.

Rob Reardon, MD

(rfreardon@gmail.com)Scott Joing, MD

Chandler Hill, MD

Department of Emergency MedicineHennepin County Medical Center

Minneapolis, MN

Supporting Information

The following supporting information is available in the onlineversion of this paper:

Video Clip S1. Bougie-assisted cricothyrotomy technique.The video clip is in QuickTime.Please note: Wiley Periodicals Inc. is not responsible for the

content or functionality of any supporting information suppliedby the authors. Any queries (other than missing material)should be directed to the corresponding author for the article.

Figure 1. Still image of cricothyrotomy. The bougie has been placed into the trachea through the cricothyroid membrane. Thetracheal hook has been used to grasp the cricoid ring inferior to the cricoid membrane and it remains in place until the procedureis completed.

ª 2010 by the Society for Academic Emergency Medicine ISSN 1069-6563doi: 10.1111/j.1553-2712.2009.00638.x PII ISSN 1069-6563583 225

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