Bystander cricothyrotomy with ballpoint pen: a fresh cadaveric feasibility study.
OBJECTIVE
In motion pictures and anecdotal reports, ballpoint pens have been used for life-saving cricothyroidotomies. The objective of this study was to examine the widespread belief that ballpoint pens can perforate the skin and cricothyroid ligament and could be used as substitute tracheostomy sets in an emergency setting.


METHODS
Three different ballpoint pens were examined regarding their inner diameter, their demountability to form a cannula and their airflow properties. Ten medical laypersons were asked to try to puncture the trachea through the skin and the cricothyroid ligament in 10 fresh cadavers just using the ballpoint pens.


RESULTS
Two of three pens had inner diameters of >3 mm and were both suitable as cannulas in a tracheotomy. All participants could perforate the skin with both ballpoint pens. However, almost no one could penetrate through the cricothyroid ligament or the ventral wall of the trachea, except for one participant. He performed the tracheostomy after three attempts in >5 min with a lot of patience and force.


CONCLUSIONS
A cricothyroidotomy just with a ballpoint pen is virtually impossible. First, the airflow resistance in commercially available ballpoint pens is too high to produce effective ventilation. Second, the cricothyroid ligament is too strong to be penetrated by ballpoint pens.
Department of Head and Neck Surgery, Ludwig-Maximilians-University Munich, Munich, Germany.
Ulrich
U
Kisser
Institute of Legal Medicine and Forensic Sciences, Ludwig-Maximilians-University Munich, Munich, Germany.
Christian
C
Braun
Department of Head and Neck Surgery, Ludwig-Maximilians-University Munich, Munich, Germany.
Astrid
A
Huber
HNO Zentrum Mangfall-Inn, Rosenheim, Germany.
Klaus
K
Stelter
D000402:Airway Obstruction / Q000517:prevention & control*; D000403:Airway Resistance; D002102:Cadaver; D003413:Cricoid Cartilage / Q000601:surgery*; D004867:Equipment Design; D006794:Household Articles; D006801:Humans; D014139:Tracheostomy / Q000295:instrumentation*
ENT; acute care; airway; basic ambulance care; prehospital care