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Cricothyroidotomy involves exposure and incision of the cricothyroid membrane (directly inferior to the thyroid cartilage) and direct insertion of a tracheostomy or endotracheal tube into the trachea (Figure 3.10). In the classic “open technique,” the operator identifies the thyroid and cricoid cartilages, uses a scalpel to place a longitudinal midline incision over the spaces between them, transversely incises the cricothyroid membrane, and places a tracheostomy tube or 6.0 endotracheal tube through the opening and into the trachea. Some clinicians prefer a transverse incision through the skin, although this approach may heighten the risk of inadvertent thyroid vessel laceration.

An alternate approach uses commercially packaged Seldinger‐type devices. For example, the Pertrach™ kit consists of a needle, wire, dilator, and cannula. The rescuer makes a small skin incision and inserts a needle/dilator combination through the cricothyroid membrane, subsequently using the dilator to spread the tissues. The rescuer can then feed the tracheal tube over the guidewire and into the trachea.

Limited data describe the complications associated with prehospital cricothyroidotomy [54–57]. EMS medical directors question the role of cricothyroidotomy in the field, citing the difficulty of the procedure and its infrequency, with associated need to maintain appropriate competencies [58].