Cricothyrotomy vs. tracheostomy: What is the difference?

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A cricothyrotomy involves an incision through the skin and a membrane in the throat to establish an airway. The aim is to quickly relieve airway obstruction in cases of choking, anaphylaxis, or airway trauma.

Conversely, a tracheostomy entails creating an opening lower down the throat directly into the trachea through the neck. A medical professional then inserts a tube to facilitate breathing.

The choice between these two procedures hinges on the urgency of the situation, the person’s overall health, and the anticipated need for airway support.

Healthcare professionals use cricothyrotomy in emergency situations where securing an airway quickly is paramount. The procedure is fast and easier to perform than others and tends to cause less bleeding.

This procedure is for short-term use. Medical professionals may use it until the airway is no longer obstructed or there is a more long-term solution they can switch to instead.

Situations in which a health professional may perform a cricothyrotomy include:

• Acute airway obstruction: This includes situations where foreign objects, swelling, or anaphylaxis block the upper airway, preventing a person from being able to breathe.
• Severe trauma: Trauma, or injuries, to the face and neck can interfere with breathing. Depending on the injury, it may also not be possible to use intubation, which is when health professionals insert a tube through the nose or mouth to restore breathing. In this situation, a cricothyrotomy may be a solution.
• Rapid deterioration: Other people who cannot breathe as they should, but who cannot undergo intubation or ventilation, may also have a cricothyrotomy.

In contrast, tracheostomy is a more stable long-term solution for airway management, allowing for comfort and more straightforward airway clearance.

Surgeons often perform a tracheostomy in a controlled setting. It may be a next step following a temporary cricothyrotomy or a new treatment for chronic respiratory conditions. However, healthcare professionals can also use it in emergencies.

Potential uses for a tracheostomy include:

• Long-term ventilation: People in critical care requiring extended mechanical ventilation may undergo a tracheostomy.
• Upper airway obstructions: People with tumors, infections, or large goiters that doctors cannot rapidly resolve or bypass may benefit from a tracheostomy.
• Chronic respiratory conditions: Doctors may recommend tracheostomies for severe obstructive sleep apnea or chronic obstructive pulmonary disease (COPD) when less invasive treatments do not work.
• Neurological conditions: People with conditions affecting their ability to breathe independently or clear secretions from the airway may have a tracheostomy.

The main benefit of both cricothyrotomy and tracheostomy is that both restore airway access and the ability to breathe. However, each procedure has unique advantages.

The benefits of cricothyrotomy include:

• rapid airway access
• minimal need for equipment
• short procedure time

The benefits of tracheostomy include:

• long-term airway access for people who need it
• enhanced comfort, allowing people to speak and eat with less difficulty than with intubation
• lower risk of airway injury or damage to the vocal cords in comparison to prolonged intubation

All medical procedures, including cricothyrotomy and tracheostomy, carry risks. The risks of a cricothyrotomy include:

• bleeding
• injuries to the surrounding tissues and structures
• perforation of the trachea
• infection

The risks of a tracheostomy include:

• bleeding
• infection
• collapsed lung (pneumothorax)
• tissue death

There can also be a psychological impact from these procedures. The distress of experiencing a health emergency, or adjusting to a long-term condition, can be very stressful. A person may also have voice changes or, later on, a scar on their throat, that affect self-image.

Medical professionals carefully weigh the risks and benefits before proceeding with any surgery.

To perform a cricothyrotomy, a health professional will typically:

1. Gather necessary equipment and prepare the person for the procedure by positioning them with the neck extended if possible.
2. Apply a local anesthetic to the site if possible.
3. Identify landmarks on the body to find the right place to cut.
4. Make a vertical incision through the skin over the cricothyroid membrane, then extend the incision to access the airway.
5. Insert a cricothyrotomy or tracheostomy tube through the incision into the trachea to establish an airway, then confirm placement by assessing for adequate ventilation.
6. Secure it with ties or sutures and connect it to a ventilation source if necessary or possible.

To perform a tracheostomy, a health professional will usually:

1. Position the person with the neck extended to expose the surgical site.
2. Administer a general anesthetic to ensure the person is unconscious and pain-free during the procedure.
3. Make a horizontal or vertical incision in the lower part of the neck, centered over the trachea.
4. Carefully dissect the tissue layers to expose the trachea, using retractors to maintain visibility and access.
5. Identify the appropriate area and make an incision into the trachea to create an opening.
6. Insert a tracheostomy tube through the opening into the trachea.
7. Check for air return to ensure correct placement.
8. Tie or suture the tracheostomy tube and attach it to a breathing circuit or humidified air, as appropriate.

Recovery from cricothyrotomy involves monitoring for complications. If the individual has pain at the incision site, a doctor may recommend medications to manage it.

If a person requires long-term airway support, their healthcare team may plan for transitioning to a tracheostomy once the individual is stable.

Recovery from tracheostomy is more involved. It may require a hospital stay for those needing comprehensive respiratory support with underlying health conditions.

Individuals and caregivers receive training on tracheostomy care, including how to clean and change the tube, suctioning techniques, and signs of infection. Speech and language therapists may also assist the person in adapting to breathing through a tracheostomy tube and addressing any swallowing difficulties.

The recovery journey post-cricothyrotomy or tracheostomy requires a coordinated effort from a multidisciplinary healthcare team, including surgeons, nurses, respiratory therapists, and rehabilitation specialists, to support the person’s return to optimal health and function.

Learn about caring for a tracheostomy.

Both cricothyrotomy and tracheostomy restore air flow when there is an obstruction in the throat. However, they have different advantages.

Cricothyrotomy offers a quick, temporary solution in emergencies where immediate airway access is necessary. Tracheostomy provides a stable, long-term airway suitable for people who require ongoing help breathing.

Both procedures have benefits and risks, but medical professionals carefully consider these to ensure optimal health outcomes for the individual.