Cricothyroidotomy in extreme emergency: A case report of a real-life experience in three steps and less than 30 s using a single blade.

INTRODUCTION AND IMPORTANCE: Cricothyroidotomy is often the last resort when conventional ventilation devices prove ineffective. The conventional procedure that involves several steps and requires the completion of a preoperative checklist. This report describes a novel approach to cricothyroidotomy, allowing quick access to the cricothyroid membrane in fewer steps.

CASE PRESENTATION: We present the case of a 26-year-old male with Schimmelpenning syndrome, exhibiting significant anatomical deformity. Following surgery for temporomandibular joint replacement, the patient developed a hematoma requiring urgent intervention. During nasotracheal intubation, the patient experienced a significant drop in oxygen saturation, which required prompt cricothyroidotomy. The procedure was performed in less than 30 s using a single blade for incising the tissues and the surgeon's hands for dissection and retraction. The procedure resulted in immediate recovery of the patient's oxygen saturation.

CLINICAL DISCUSSION: In contrast to previously reported multi-step procedures, this study reports a simpler three-step cricothyroidotomy. The technique involves a vertical skin incision, blunt dissection using the surgeon's fingers, and a horizontal incision on the cricothyroid membrane. The procedure was executed with the patient in a semi-reclined position, optimizing time efficiency.

CONCLUSION: This case highlights the efficacy of a rapid cricothyroidotomy technique in extreme emergencies. The presented technique requires minimal instrumentation and can be completed quickly in an emergency situation, even in the presence of anatomical variations.