Needle cricothyrotomy

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  • Failed airway in adults or children
    • Preferred method of rescue airway in infants and children (cutoff 5-12 years of age, depending on source[1])
  • Temporizing measure until definitive airway management
  • Obstruction above the level of the cricothryoid membrane


When used as a rescue airway, no absolute contraindications.

  • Relative Contraindications
    • Inability to identify landmarks
    • Tracheal transection or severe trauma
    • Underlying tumor, abscess/infection, or other known abnormality


  • Provodone iodine
  • Sterile drapes, gloves, gown, gauze
  • 12-14 G angiocath
  • 3mL syringe x 2
  • Adapter to 7-0 ETT or adapter to 3-0 ETT
  • BVM appropriate for size of patient
    • Can also use jet vet ventilation setup in adults
      • High flow O2 source, 50 PSI
      • O2 tubing
      • Valve-3 way stop cock or cut holes in O2 tubing
      • Depending on O2 source, calculate time valve must be open for tidal volume
      • BVM setup does not allow adequate exhalation in adults


  1. Prep and drape
  2. Locate cricothyroid membrane
  3. Pierce membrane with angiocath directed 30-45 deg caudal
    • Attach 3mL syringe with saline, aspirate as you enter
    • Advance until air is aspirated in syringe
  4. Advance catheter over needle, hub to skin
    • Remove needle
  5. Attach 3 mL syringe to catheter, then attach 7-0 ETT adapter to syringe
    • Or can attach 3-0 ETT adapter directly to angiocath
  6. Attach BVM to ETT adapter
  7. Secure system
  8. Ventilate with BVM or high flow O2 setup
    • Should be used for < 45 minutes


  • Hemorrhage
  • Infection
  • Tracheal stenosis
  • Subcutaneous emphysema
  • Posterior tracheal perforation

See Also


  1. In Roberts, J. R., In Custalow, C. B., In Thomsen, T. W., & In Hedges, J. R. (2014). Roberts and Hedges' clinical procedures in emergency medicine.