Surgical cricothyroidotomy provides a definitive airway (a cuffed tube in the trachea) if tracheal intubation is not possible.

Unlike tracheostomy, it can be performed quickly and does not require a surgeon

Technique for a surgical cricothyroidotomy is:

1. Extend the patient's neck fully - a rapid way to do this is to pull the patient up the trolley until the head hangs over the end. In a can't intubate can't oxygenate situation the risk of death due to hypoxia outweighs the risk of worsening a cervical spine injury
2. Identify the cricothyroid membrane (Fig 1)
3. Using a scalpel, make a single horizontal stab incision through the skin and cricothyroid membrane (Fig 2)
4. Enlarge the hole using artery forceps or tracheal dilators, or by rotating the scalpel through 90 degrees (Fig 3)
5. Insert a gum elastic bougie to 10-15cm - you may feel clicks or hold-up (Fig 4)
6. If available, you can use a Rapifit connector on the end of the bougie to connect to a bag-valve-mask and re-oxygenate the patient
7. Insert a size 6 cuffed tracheal or tracheostomy tube over the bougie, rotating clockwise
8. Remove the bougie, inflate the cuff, check the position and ventilate

Surgical cricothyroidotomy should not be used in children - needle cricothyroidotomy with jet ventilation should be used instead.