Ultrasound for identifying the cricothyroid membrane prior to the anticipated difficult airway

The American Journal of Emergency Medicine
Stephen Alerhand

Abstract

Prior to the anticipated difficult airway, the emergency physician commonly palpates the neck to identify the presumed location of the cricothyroid membrane (CTM). In the event of a "cannot-intubate, cannot‑oxygenate" airway, precise CTM localization is vital to the success of a cricothyrotomy and hence, the patient's survival. This narrative review will summarize the prospective studies evaluating CTM identification. It will demonstrate the inaccuracy of the classically used landmark palpation technique. It will then describe the use of ultrasound (US) as a superior tool for CTM identification, illustrate the technique itself, and propose its implementation in the pre-intubation checklist for the anticipated difficult airway. Evidence demonstrates that physicians are not sufficiently accurate in palpating the CTM in both cadavers and volunteers in a stable non-emergent setting. In preparing for a real-time intubation, this fine motor task would be more difficult to achieve. Moreover, this particular patient group may often exhibit difficult airway features. US has been demonstrated to be superior for locating the CTM than landmark palpation across body habitus, gender, and failed airway simulations. This technique carries a sh...Continue Reading

Citations

Dec 20, 2019·Canadian Journal of Rural Medicine : the Official Journal of the Society of Rural Physicians of Canada = Journal Canadien De La Médecine Rurale : Le Journal Officiel De La Société De Médecine Rurale Du Canada·Tyler M C Johnston, Philip J Davis
Sep 25, 2020·Chest·Daniel R AustinEdward A Bittner

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