The initial steps of performing a cricothyroidotomy are common to all of the CoTCCC-recommended techniques. They include:
- Identifying the cricothyroid membrane between the thyroid cartilage and the cricoid cartilage
- Holding the trachea with the nondominant hand to stabilize the airway.
- Making a vertical skin incision from the inferior edge of the thyroid cartilage to the top of the cricoid cartilage (incising down to the cricothyroid membrane)
- Dissect the tissues to expose the membrane, and
- Making a horizontal incision through the cricothyroid membrane.
From there, each technique uses a different approach to establishing the airway. Identifying the landmarks properly and exposing the membrane is where most errors occur, and it is important to take advantage of as many training opportunities as you can to improve that skill, including practicing landmark identification on one another. The following are reasons why common errors occur:
- Limited anatomical instruction
- Lack of “hands-on” familiarization with laryngeal anatomy
- Non-standardized step-by-step training in the surgical technique involved
- Anatomically incorrect training manikins
- Lack of standardized refresher training frequency