Abstract
The successful management of a ‘can’t intubate can’t oxygenate’ (CICO) situation includes performing front of neck access (FONA) via the cricothyroid membrane. Technical difficulties can contribute to failure in patients with a smaller height of cricothyroid membrane. We studied the height of the cricothyroid membrane in patients presenting for elective surgery. This single-centre, observational cohort study took place at University Hospitals Coventry & Warwickshire NHS Trust, England. Patients aged 18 or above and scheduled for surgery under general anaesthesia were invited to participate. Following written informed consent and detailed airway assessment, ultrasonography of the neck was performed with the patient supine and the neck extended, with no transducer pressure in the longitudinal plane. Data from 1366 patients was analysed. The mean (SD) height of the cricothyroid membrane was 10.8 (1.9) mm in male patients and 9.8 (1.8) mm in female patients (p < 0.001). The mean height of the cricothyroid membrane was ≥8.0 mm in 91% of patients. In patients with short stature, the height of the cricothyroid membrane was significantly smaller in both male and female patients. In this group, the use of ultrasonography to determine the height of the cricothyroid membrane prior to induction of anaesthesia would be prudent.
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