Ep 246: POCUS of the Cricothyroid Membrane

Check out the timestamps below to help you navigate through the many topics we discussed.

On This Episode:

Emergency cricothyrotomy is a rare, but incredibly important procedure that can be lifesaving. A primary step when performing a cricothyrotomy is correct identification of the cricothyroid membrane (CTM). Point of Care Ultrasound of the CTM has shown to be the most helpful in obese and altered neck anatomy populations. However, this technique is not routinely utilized in current anesthesia and critical care practice.

In this episode Jeremy and Sass discuss the anatomy related to the CTM. They talk about palpation methods for finding the CTM, discuss current evidence for the use of ultrasound identification, and break down the ultrasound techniques that are useful in clinical practice. This is the podcast that will excite you to use POCUS for identification of the CTM!

Here are some of the things you’ll learn on this show:

• Understanding and identifying the anatomy. [2:21]
• The two most effective ways to find the cricothyroid membrane. [8:32]
• A couple of relevant studies that provide good information. [12:45]
• The ultrasound procedure to help identify it. [17:19]
• The educational resources that Jeremy recommends. [21:48]
• The String of Pearls technique. [22:40]

Check out the interview at the top of the page and use the timestamps to help you navigate through the many topics we discussed.

Show Notes & Resources:

1. 1. Kristensen MS, Teoh WH, Rudolph SS. Ultrasonographic identification of the cricothyroid membrane: best evidence, techniques, and clinical impact. Br J Anaesth. 2016 Sep;117 Suppl 1:i39-i48. doi: 10.1093/bja/aew176. Epub 2016 Jul 17. PMID: 27432055.
   2. Rai Y, You-Ten E, Zasso F, De Castro C, Ye XY, Siddiqui N. The role of ultrasound in front-of-neck access for cricothyroid membrane identification: A systematic review. J Crit Care. 2020 Dec;60:161-168. doi: 10.1016/j.jcrc.2020.07.030. Epub 2020 Aug 13. PMID: 32836091. Journal of Anaesthesia, Volume 117, Issue suppl_1, September 2016, Pages i39–i48, https://doi.org/10.1093/bja/aew176
   3. Hung KC, Chen IW, Lin CM, Sun CK. Comparison between ultrasound-guided and digital palpation techniques for identification of the cricothyroid membrane: a meta-analysis. Br J Anaesth. 2021 Jan;126(1):e9-e11. doi: 10.1016/j.bja.2020.08.012. Epub 2020 Sep 28. PMID: 32896429.
   4. Kristensen MS, Teoh WH. Ultrasound identification of the cricothyroid membrane: the new standard in preparing for front-of-neck airway access. Br J Anaesth. 2021 Jan;126(1):22-27. doi: 10.1016/j.bja.2020.10.004. Epub 2020 Oct 31. PMID: 33131758.
   5. Siddiqui N, Arzola C, Friedman Z, Guerina L, You-Ten KE. Ultrasound Improves Cricothyrotomy Success in Cadavers with Poorly Defined Neck Anatomy: A Randomized Control Trial. Anesthesiology. 2015 Nov;123(5):1033-41. doi: 10.1097/ALN.0000000000000848. PMID: 26352376.
   6. Airway Management for Anaesthesiologists. Ultrasound guided marking of the cricothyroid membrane using:
      1. Transverse TACA Technique: https://airwaymanagement.dk/ultrasound_needle_cricothyrotomy
      2. Longitudinal “String of Pearls” Technique: airwaymanagement.dk/pearls