There are a number of factors that can make the performance of a cricothryotomy particularly challenging - lack of familiarity with the procedure, poor landmarks, or any of the known predictors of difficult via the SHORT acronym. But the cognitive barriers to performing this procedure dwarf any technical barriers.

It is critical that when a can't intubate, can't ventilate scenario arises, the leader of the resuscitation verbalizes the situation and verbalizes the need to perform a cricothyrotomy. (See this video by Yen Chow, MD for a good example of clear communication during this situation) When you are visualizing yourself in this situation, performing this procedure and when you are practicing in the simulation center, don't forget to practice your communication.

It is also important to be prepared to do this procedure on each and every airway. When verbalizing the plan for laryngoscopy, verbalize your plan for cricothyrotomy. Have the kit out. If you feel there is a significant chance the patient will need to have a cricothyrotomy performed, go ahead and prep the neck, locate and mark your landmarks, open up the kit, maybe even inject some lidocaine with epinephrine. (See the EMCrit post on CricCon for more discussion of this).

Prepping the Patient and Prepping yourself

Prepping the Patient's Neck

Should use either chlorhexidine or betadine to clean the skin in preparation for the procedure

Anesthetize using 1% lidocaine w/ Epinephrine

Preparing Yourself

Put a face shield on as this procedure can be quite bloody with a high probability of blood spray once you enter the airway (see the video of a cricothyrotomy performed on a real patient as evidence)

Calm yourself - tactical breathing to decrease your heart rate and your stress as you get ready to perform the procedure

Identify the Relevant Anatomy & Give the Larynx a Handshake