Needle Cricothyrotomy

Needle cricothyrotomy with percutaneous translaryngeal ventilation (PTLV) can be a life-saving procedure when an emergency airway is needed. Needle cricothyrotomy is preferred over surgical cricothyrotomy in infants and young children. Appropriate ventilatory parameters using a high-flow oxygen source and an adequate expiratory time (inhalation–exhalation ratio) may limit the complications of barotrauma and allow for a more extended time of ventilation. Preliminary reports suggest that PTLV may be also useful in the endotracheal intubation of patients who have a difficult or failed airway and may help prevent aspiration, although further studies are needed. The emergency physician should be familiar with the indications, contraindications, complications, and procedure of this type of rescue airway, which is also used to ventilate patients during elective laryngeal surgery.