Emergency airway puncture

• Alternative Names

  Needle cricothyrotomy

• Description

  In an emergency situation, when someone is choking and all other efforts to assist with breathing have failed, a hollow needle or tube can be inserted into the throat, just below the Adam's apple (cricoid cartilage).

  In a hospital setting, a small cut in the skin is made before inserting the needle.

• Why the Procedure Is Performed

  A cricothyrotomy is recommended as an emergency procedure to relieve an airway obstruction until surgery can be done to place a breathing tube (tracheostomy).

• Risks

  Risks for any surgery are:

  • Bleeding
  • Infection

  Additional risks include trauma to the voice box (larynx), thyroid gland, and esophagus, and perforation (tearing) of the lungs and other body parts in the chest, leading to a collapsed lung and air collecting around the heart.

• After the Procedure

  Emergency airway puncture (cricothyrotomy) can be quite effective in temporarily relieving an airway obstruction, but it must quickly be replaced by a more effective means of ventilation.

• Outlook (Prognosis)

  What happens will depend on the cause of the airway obstruction and how quickly the person receives a better means of ventilation.

  See: Tracheostomy

• References

  Goldenberg D, Bhatti N. Management of the impaired airway in the adult. In: Roberts JR, Hedges JR. Clinical Procedures in Emergency Medicine. 4th ed. Philadelphia, Pa: Saunders Elsevier; 2004: chap 106.

  Rubin M, Sadovnikoff N. Pediatric airway management. In: Tintinalli JE, Kelen GD, Stapczynski JS, Ma OJ, Cline DM, eds. Emergency Medicine: A Comprehensive Study Guide. 6th ed. New York, NY: McGraw-Hill; 2004: chap 15.

  Thomas SH, Brown DFM. Foreign bodies. In: Marx J. Rosen’s Emergency Medicine: Concepts and Clinical Practice. 6th ed. St. Louis, Mo: Mosby Elsevier; 2006: chap 57.

Review Date: 7/19/2009

Reviewed By: Jacob L. Heller, MD, MHA, Emergency Medicine, Virginia Mason Medical Center, Seattle, WA. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.