Inappropriate delay of establishing a surgical definitive airway with a cricothyrotomy has been documented in field and hospital operations1,2. This can be attributed to many factors including:

  • Failure to recognize Can’t Intubate-Can’t Ventilate scenario.
  • Not appreciating the seriousness of patient condition after multiple failed endotracheal intubation attempts.
  • Overdependence on endotracheal intubation adjuncts including video laryngoscopy, supraglottic airways, intubating endoscopes, gum-elastic bougie.
  • Reluctance to proceed to invasive surgical procedure.
  • Inexperience with surgical cricothyrotomy.

Cognitive aides such as the