Needle Cricothyrotomy in Pediatrics
Needle Cricothyrotomy in Pediatrics
Overview
Needle cricothyrotomy is a life-saving emergency airway procedure performed when less invasive methods of securing an airway have failed. In pediatric patients, it serves as a temporary measure to provide oxygenation until a definitive airway can be established.
Key Points
- Temporary measure providing up to 45-60 minutes of oxygenation
- Preferred over surgical cricothyrotomy in children under 12 years
- Success rates significantly depend on provider experience and anatomy identification
- Required equipment must be readily available in emergency settings
Clinical Indications
- Complete upper airway obstruction
- Failed intubation and ventilation
- Severe facial trauma preventing standard airway management
- Angioedema or epiglottitis unresponsive to other interventions
Anatomical Considerations
- Higher laryngeal position in children
- More pliable cricoid cartilage
- Smaller cricothyroid membrane (4-7mm vertical height in children)
- More anterior vocal cords
Required Equipment
- 14-16 gauge IV catheter
- 3mL syringe
- Oxygen source with high-pressure tubing
- Jet ventilation device (if available)
- Antiseptic solution
- Sterile gloves
Procedure Technique
- Position patient supine with neck extended
- Identify cricothyroid membrane
- Prepare skin with antiseptic
- Stabilize larynx with non-dominant hand
- Insert catheter at 45-degree angle caudally
- Confirm placement with air aspiration
- Attach jet ventilation device or improvised ventilation system
- Secure catheter
Complications
- Bleeding
- Posterior wall perforation
- Subcutaneous emphysema
- Pneumothorax
- Catheter kinking or dislodgement
Post-Procedure Care
- Continuous monitoring of oxygenation and ventilation
- Prepare for definitive airway management
- Monitor for complications
- Document procedure and outcomes
