Indications: ‘cannot ventilate, cannot intubate’

Equipment needed:

• 18g cannula, 10 ml syringe, 5 ml saline (to confirm the location of trachea, by aspirating air)
• Manujet (with pressure control proportional to age)

Technique:

• Attach a 10 ml syringe to the cannula. Insert the cannula at an angle of 45 degrees towards the feet through the cricothyroid membrane in the midline.

• Confirm the location of the cannula in the trachea by aspirating air into syringe. Advance the cannula into the trachea and remove the needle.
• Secure the cannula in place and connect the manujet system through the connecting tube that comes with the manujet.
• The other end of the manujet system is connected to the oxygen outlet on the wall or oxygen cylinder.
• Set the pressure limit on the manujet according to the age group, before starting to ventilate. Press the handle on the manujet for about a second. Check the ventilation by seeing the chest rise. Increase the pressure slowly (to a maximum of 40) until satisfactory chest rise or an improvement in oxygenation is achieved.
• • It is important to visualise the chest fall as well during the 3–4 second pause between manujet inflations. This is achieved by maintaining a patent airway (supraglottic) or by attaching a three way tap to the tubing connected to the manujet, which is then opened to the atmosphere from the trachea.

Potential complications:

• Failure to identify trachea
• Subcutaneous / mediastinal emphysema
• Bleeding

Surgical cricothyroidotomy

Surgical cricothyroidotomy is usually reserved for children above 12 years of age.

→ Section 6.c.i

Surgical airway