Cricothyroidotomy
As tracheostomy takes longer and is more difficult to perform, cricothyroidotomy is done during an emergency to establish an airway.

Tracheostomy is a procedure to create an opening (stoma) on the front of the neck up to the windpipe (trachea). A special tube (tracheostomy) is then placed in the opening to aid breathing. Tracheostomy is done when the usual route for breathing is blocked or narrowed. A tracheostomy is often needed when health problems require long-term use of a machine (ventilator) to assist breathing. Sometimes an emergency tracheotomy may be performed when the airway is suddenly blocked, such as after a trauma to the face or neck. A tracheostomy needs anesthesia, unlike the cricothyroidotomy.

When a tracheostomy is no longer needed and the patient can breathe on their own, the tube is removed, and the opening is allowed to close on its own or is closed surgically. In some cases, a tracheostomy is permanent. Most tracheotomies are performed in a hospital. Sometimes, it may be performed in case of an emergency/accident when there is no other way to secure the airway.

As tracheostomy takes longer and is more difficult to perform, cricothyroidotomy is done during an emergency to establish an airway. It is a surgical procedure that is easier to perform, causes less bleeding, and takes lesser time. It is sometimes referred to as an “emergency tracheostomy.” A cut is made through the skin near Adam’s apple (cricothyroid membrane) and a tracheostomy tube or endotracheal tube of 6- or 7-mm internal diameter is then inserted.

When is a tracheostomy done?

Tracheostomy may be indicated in the following situations:

  • Medical conditions that require a ventilator for breathing for an extended period, usually more than 1 or 2 weeks.
  • Medical conditions that block or narrow the airway, such as vocal cord paralysis or throat cancer.
  • Neurological problems or other conditions that cause paralysis, making it difficult to cough out secretions from the throat.
  • Preparation for a major head or neck surgery to assist breathing during recovery.
  • Trauma to the head or neck causing severe neck swelling and choking.
  • Other emergencies.

When is cricothyroidotomy done?

Cricothyroidotomy is usually indicated in emergency, life-threatening situations when there is no time to perform a tracheostomy, such as:

  • Foreign body obstructing the airway
  • Angioedema (swelling in the neck, face, or throat)
  • Massive trauma to the face or neck
  • Inability to ventilate or insert a breathing tube through the mouth

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What happens after the tracheostomy procedure?

The patient would have to stay in the hospital till they get better, which could take a few days to weeks or months. The patients will need rehabilitation and training to cope with the tracheostomy, these include:

  • Caring for the tracheostomy tube: A healthcare professional will teach the patient and caregiver the ways to clean and change the tracheostomy to prevent infection and reduce the risk of complications.
  • Speaking: The patient is usually unable to speak after tracheostomy. However, there are different devices and techniques to aid the production of speech in these people.
  • Eating: The patient may not be able to swallow initially. They will receive nutrients through an intravenous (IV) line or a feeding tube that passes through the nose, mouth, food pipe (esophagus), and into the stomach.
  • Humidification of air: Normally, the nose moistens the air. The air that passes through the tube is dry, which causes irritation, cough, and excess mucus secretion. Putting small amounts of saline into the tracheostomy tube as directed, a saline nebulizer, a humidifier, or vaporizer can moisten the inhaled air.
  • Managing other problems: There are other common side effects of having a tracheostomy, such as excess secretions for which regular suctioning is required. A healthcare provider will teach the caregiver how to suction at home.

What are the complications?

The risk of complications following tracheostomy and cricothyrotomy is low. However, there is a possibility of encountering immediate and long-term complications.

Immediate complications include:

  • Bleeding
  • Damage to the trachea and/or surrounding structures
  • Displacement of the tracheostomy tube
  • Air trapped in the tissue under the skin of the neck (subcutaneous emphysema)
  • Pneumothorax (air trapped between the chest wall and lungs, causing pain, breathing difficulty, or lung collapse)
  • Hematoma (collection of blood) can compress the trachea

Long-term tracheostomy complications include:

  • Obstruction of the tracheostomy tube
  • Displacement of the tracheostomy tube
  • Scarring or narrowing of the trachea
  • Development of an abnormal passage between the trachea and the esophagus (tracheoesophageal fistula)
  • Infection

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Medically Reviewed on 1/11/2021
References
Medline Plus. Tracheostomy. https://medlineplus.gov/ency/article/002955.htm

American Cancer Society. What Is a Tracheostomy? https://www.cancer.org/treatment/treatments-and-side-effects/treatment-types/surgery/ostomies/tracheostomy/what-is-tracheostomy.html

Khan H. Cricothyroidotomy. Medscape. https://emedicine.medscape.com/article/1830008-overview