Cricothyroidotomy for definitive airway management:

• 1) Many medics and other providers operating independently in far-forward environments are trained to use cricothyroidotomy as their primary definitive airway. While the use of a surgical airway first line is appropriate in patients presenting in-extremis or with the loss of an airway (e.g., severely injured trauma patients with facial or neck trauma), patients with COVID-19 generally present with gradually progressive symptoms and intact native airways.
• 2) Early intra-theater transfer to a facility with advanced capabilities is preferable to early cricothyroidotomy whenever possible.
• 3) Laryngeal mask airway or other supraglottic airway placement may be a sufficient bridge to definitive airway placement. Placement of a mask over the LMA (hole cut in the middle of the mask for the LMA) will minimize aerosol spread from any air leak.  PEEP above 10 cm H₂O via LMA may not be effective and may exacerbate any leak around the LMA.  Sedation and analgesic requirements for an LMA may be slightly more than with a cricothyroidotomy.
• 4) Cricothyroidotomy without the ability to provide mechanical ventilation consumes significant resources (manpower required to bag-ventilate the patient with PEEP, inefficient delivery of oxygen via bag-ventilation, and significant aerosol risk to those providing care).