Three-step emergency cricothyroidotomy.
OBJECTIVE
Surgical cricothyroidotomy is the airway of choice in combat. It is too dangerous for combat medics to perform orotracheal intubation, because of the time needed to complete the procedure and the light signature from the intubation equipment, which provides an easy target for the enemy. The purpose of this article was to provide a modified approach for obtaining a surgical airway in complete darkness, with night-vision goggles.


METHODS
At our desert surgical skills training location at Nellis Air Force Base (Las Vegas, Nevada), Air Force para-rescue personnel received training in this technique using human cadavers. This training was provided during the fall and winter months of 2003-2006.


RESULTS
Through trial and error, we developed a "quick and easy" method of obtaining a surgical airway in complete darkness, using three steps. The steps involve the traditional skin and cricothyroid membrane incisions but add the use of an elastic bougie as a guide for endotracheal tube placement. We have discovered that the bougie not only provides an excellent guide for tube placement but also eliminates the use of additional equipment, such as tracheal hooks or dilators. Furthermore, the bevel of the endotracheal tube displaces the cricothyroid membrane laterally, which allows placement of larger tubes and yields a better tracheal seal.


CONCLUSIONS
Combat medics can perform the three-step surgical cricothyroidotomy quickly and efficiently in complete darkness. An elastic bougie is required to place a larger endotracheal tube. No additional surgical equipment is needed.
MacIntyre
Allan
A
Department of Surgery, University of Nevada School of Medicine, Las Vegas, NV 89102, USA.
Markarian
Mark K
MK
Carrison
Dale
D
Coates
Jay
J
Kuhls
Deborah
D
Fildes
John J
JJ
D002102:Cadaver; D003413:Cricoid Cartilage / Q000601:surgery*; D004632:Emergency Medical Services; D005240:Feasibility Studies; D006801:Humans; D008887:Military Medicine; D013965:Thyroidectomy / Q000379:methods*; D014481:United States; D014857:Warfare