Surgical cricothyrotomy is a life-saving airway procedure used when conventional airway management has failed or is unlikely to succeed. The procedure provides direct access to the trachea through the cricothyroid membrane and may be the only option for restoring oxygenation and ventilation in a critically injured patient.

The decision to perform a surgical airway comes down to one question:

Can the patient be ventilated and oxygenated?

If yes — continue with what is working.

If no — and the patient cannot be ventilated or oxygenated despite appropriate interventions, surgical cricothyrotomy may be required.

Situations that may indicate a surgical airway include: 

• Severe maxillofacial trauma
• Complete airway obstruction
• Massive facial bleeding
• Severe facial or airway burns
• Rapidly progressing airway swelling
• Failed airway management attempts
• Cannot Intubate, Cannot Oxygenate

While surgical cricothyrotomy is often considered a last resort, providers should recognize that certain injuries make conventional airway management unlikely to succeed from the start. In these situations, early recognition and decisive action are necessary — waiting for complete airway loss is not an option. 

The goal of airway management is not placement of a specific device. The goal is adequate oxygenation and ventilation.

Remember: If you cannot ventilate, you cannot oxygenate. If you cannot oxygenate, the patient will die.