One of the recently introduced specialized surgical cricothyrotomy kits (Control-Cric, Rusch QuickTrach, Portex Cricothyroidotomy Kit) is the Pertrach Emergency Cricothyrotomy Kit by Pulmodyne. It uses a percutaneous needle to enter the trachea, and then a dilator to insert the tracheostomy tube. This is an extension of the Melker Kit which has shown to have high success rate1. However, the Pertrach kit uses an innovative splitting needle which allows the dilator to be inserted without requiring a Seldinger wire.3
- Position the patient with the neck extended.
- Prep the neck with Betadine or chlorhexidine.
- Insert the dilator in the tracheostomy tube.
- Locate the cricothyroid membrane by direct palpation, four finger widths, or neck crease2. Ultrasound can also be used once the patient is positioned.
- With the splitting needle attached to a syringe enter the cricothyroid membrane. Ensure that air aspirates easily.
- Insert the dilator tip through the needle to the hub.
- Snap the splitting needle and remove the two halves.
- Using gentle pressure, push the dilator and tracheostomy tube into the trachea.
- Remove the dilator.
- Attach your ventilator the the tracheostomy tube.
- Secure the tracheostomy tube.
- ■ Murphy C, Rooney SJ, Maharaj CH, et al. Comparison of three cuffed emergency percutaneous cricothyroidotomy devices to conventional surgical cricothyroidotomy in a porcine model. Br J Anaesth. 2011;106:57.
- Bair A, Chima R. The Inaccuracy of Using Landmark Techniques for Cricothyroid Membrane Identification: A Comparison of Three Techniques. Acad Emerg Med 2015 Aug;22(8):908.
- Akulian J, Yarmus L, et al. The role of cricothyrotomy, tracheostomy, and percutaneous tracheostomy in airway management. Anesthesiol Clin 2015 Jun;33(2):357.