Emergency airway puncture

Needle cricothyrotomy

Emergency airway puncture is the placement of a hollow needle into the airway in the throat. It is done to treat life-threatening choking.

Description

Emergency airway puncture is done 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 (thyroid cartilage), into the airway. The needle passes between the thyroid cartilage and the cricoid cartilage.
In a hospital, before inserting the needle, a small cut may be made in the skin and the membrane between the thyroid and cricoid cartilages.

Why the Procedure Is Performed

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

If the airway blockage occurs with trauma to the head, neck, or spine, care must be taken to avoid further injury to the person.

Risks

Risks for this procedure include:

Injury to the voice box (larynx), thyroid gland, or esophagus

Risks for any surgery are:

Bleeding
Infection

Outlook (Prognosis)

How well the person does depends on the cause of the airway blockage and how quickly the person receives proper breathing support. Emergency airway puncture provides enough breathing support for only a very short period of time.

Open References

References

Cattano D, Piacentini AGG, Cavallone LF. Percutaneous emergency airway access. In: Hagberg CA, Artime CA, Aziz MF, eds. Hagberg and Benumof's Airway Management. 4th ed. Philadelphia, PA: Elsevier; 2018:chap 27.

Hebert RB, Thomas D. Cricothyrotomy and percutaneous translaryngeal ventilation. In: Roberts JR, Custalow CB, Thomsen TW, eds. Roberts and Hedges' Clinical Procedures in Emergency Medicine and Acute Care. 7th ed. Philadelphia, PA: Elsevier; 2019:chap 6.

Emergency airway puncture - illustration
An emergency airway puncture may be performed if all efforts to dislodge an object from the throat have failed. The procedure involves inserting a hollow needle into the throat just below the thyroid cartilage and should only be performed by a medical professional.
Emergency airway puncture
illustration
Cricoid cartilage - illustration
The cricoid cartilage (Adam's apple) is the portion of the throat used to insert a hollow needle to assist in breathing when other attempts have failed. This procedure is also known as an emergency airway puncture or cricothyrotomy.
Cricoid cartilage
illustration
Emergency airway puncture - series
Presentation

<strong>Emergency airway puncture - series</strong><p>The larynx is a tubular structure in the neck, through which air passes to the lungs. The thyroid and cricoid cartilage form the narrowest section of this airway.</p>

<strong>Indications</strong><p>The area of the larynx bounded by the thyroid and cricoid cartilage is a frequent site for obstruction, either by swallowed foreign bodies or abnormal tissue growths. A cricothyrotomy is an emergency procedure that relieves an airway obstruction until formal surgical placement of a breathing tube (tracheostomy) is performed.</p>

<strong>Incision</strong><p>If the situation is acute, a hollow needle is inserted into the throat, just below the Adam's apple (thyroid cartilage). This is called a needle cricothyrotomy. More frequently, a small incision is made in the skin over the cricothyroid membrane, and another incision is made through the membrane between the cricoid and thyroid cartilage.</p>

<strong>Procedure</strong><p>A tube that enables breathing is inserted through the incision.</p>

<strong>Aftercare</strong><p>Cricothyrotomy is generally followed by a surgical tracheosotomy, if there is need for a prolonged use of a breathing tube. Removal of breathing tubes from both a cricothyrotomy and tracheostomy is usually followed by prompt healing of the incision site.</p>

Emergency airway puncture - illustration
An emergency airway puncture may be performed if all efforts to dislodge an object from the throat have failed. The procedure involves inserting a hollow needle into the throat just below the thyroid cartilage and should only be performed by a medical professional.
Emergency airway puncture
illustration
Cricoid cartilage - illustration
The cricoid cartilage (Adam's apple) is the portion of the throat used to insert a hollow needle to assist in breathing when other attempts have failed. This procedure is also known as an emergency airway puncture or cricothyrotomy.
Cricoid cartilage
illustration
Emergency airway puncture - series
Presentation

A Closer Look

Talking to your MD

Self Care

Tests for Emergency airway puncture

Review Date: 10/12/2020

Reviewed By: Jesse Borke, MD, CPE, FAAEM, FACEP, Attending Physician at Kaiser Permanente, Orange County, CA. Also reviewed by David Zieve, MD, MHA, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.

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Health Library

Emergency airway puncture

Description

Choking

Why the Procedure Is Performed

Airway obstruction

Tracheostomy

Risks