Pediatric Cricothyrotomy
The last line in a critically ill pediatric patient who has respiratory failure is cricothyroidotomy. Depending on the age, either needle cricothyroidotomy with jet ventilation in children < 8 years old (due to the smaller size of the cricoid membrane) or traditional cricothyroidotomy in children > 8 years old should be implemented - Zaza Atanelov MD MPH, Gwen Hooley MD and Sylvia E. Garcia MD
HWN Suggests
The pediatric can’t intubate can’t oxygenate scenario (Use a knife)
A can’t intubate can’t oxygenate scenario will always be scary, but after years of mental rehearsal and some real world experience, the idea of surgical front of neck access in an adult doesn’t bother me much. (I think that is an important mental space for emergency physicians to find if you want to be able to perform a cricothyroidotomy in a timely manner when needed.) However, the can’t intube can’t oxygenate scenario in pediatrics still scares the hell out of me. In large part this is because I have no idea what I am supposed to do. Different guidelines suggest different approaches. They often suggest procedures – such as jet ventilation – that I think are a really bad idea based on the…
Featured
Difficult to Ventilate and Oxygenate: The Pediatric Airway Overview
As a last resort, needle-cric and jet ventilation in pediatrics under 8 years old or traditional cricothyroidotomy for those patients above 8 years old can be attempted.
Articles of Interest
A Primer for Pediatric Emergency Front-of-the-Neck Access
Given the paucity of evidence, we recommend emergency tracheotomy for FONA in children 8 years or younger. For children older than 8 years, we recommend a scalpel technique or a percutaneous technique.
Can’t Intubate Can’t Ventilate
With larger children and adults, the can’t intubate can’t ventilate scenario often leads to the Cricothyrotomy. In younger children and infants, the differences in anatomy make a traditional cricothyrotomy challenging.
Cricothyroidotomy
In the setting of a CICV emergency a range of front of neck access techniques are available. These can broadly be classified into needle based and scalpel based techniques. Due to limited evidence of technique success and a plethora of potential complications these techniques are reserved as an absolute last resort. However, when indicated they should be carried out expediently as they have the potential to be life saving. These techniques are relatively straightforward and the most challenging aspect is making the decision to perform them.
Cricothyrotomy Needle
Use the largest IV catheter possible, such as a size 10 or 14 gauge in the adult. For a child choose a smaller catheter such as an 18 or 16 gauge.
Surgical Cricothyroidotomy
A collection of videos that help demonstrate the techniques for surgical cricothyroidotomy.
