Scalpel cricothyroidotomy: The importance of bougie coude tip and scalpel blade characteristics

Abstract

Scalpel cricothyroidotomy is a life-saving emergency procedure used for accessing the airway in a ‘can't intubate, can't oxygenate’ scenario. To date, various patient characteristics and imaging modalities have been investigated for improving emergency Front of Neck Access (eFONA) attempts. However, there is still a lack of consensus in determining the most effective bougie and scalpel to use. This study analysed six readily available bougies and three broad-based scalpels. We found significant heterogeneity between the coude tip angles and the depth of the bougies, as well as the cutting depth of the scalpels. Some of the bougies and scalpel blades currently available on the market may therefore be unsuitable for eFONA attempts in patients with a high body mass index (BMI) as the depth of the cricothyroid membrane is likely to be increased. We recommend anaesthetic departments, emergency departments and critical care units should review their current eFONA equipment to assess the suitability for use, particularly in patients with a raised BMI.