Localisation of the cricothyroid membrane by digital palpation in the emergency department

Hiba Alshareef, Abdulaziz Al Saawi, Faisal Almazroua, Hadi Alyami, Gerard O. Reilly, Biswadev Mitra

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2 Citations (Scopus)


Introduction: A surgical approach to airway management may be essential in situations of difficult or failed airway, where immediate airway access is needed to provide oxygenation. However, the procedure is uncommonly performed and expertise among emergency clinicians may be limited. Objectives: The aim of this study was to assess the accuracy of cricothyroid membrane (CTM) identification by junior and senior emergency trainees by identification of surface anatomy landmarks. A secondary aim was to determine patient variables associated with accurate identification of CTM. Methods: A prospective observational study was conducted in a tertiary emergency department in the Kingdom of Saudi Arabia. Saudi Emergency Medicine board trainees participated in the study. Data were also obtained on gender and body habitus of patients. Junior trainees attempted to locate the membrane by palpation and marked it with an ultraviolet mark (blinded) pen followed by senior trainees. A certified ultrasound physician, also blinded to the trainee attempts, marked the membrane within a 5 mm circumference using a different coloured ultraviolet pen and was used as the reference gold standard. Results: There were 80 patients enrolled with junior and senior doctors assessing location for emergency cricothyrotomy. Proportion of correct localisation was 30% (95% CI 20% to 41%) among junior trainees and 33% (95% CI 22% to 44%) among seniors (P=0.73). Level of training, sex, height and weight of patients were not associated with success. Conclusions: Clinical localisation of CTM by emergency medicine trainees was poor even in non-stressful settings, and warrants further dedicated education and/or use of adjunct techniques.

Original languageEnglish
Pages (from-to)442-445
Number of pages4
JournalPostgraduate Medical Journal
Issue number1114
Publication statusPublished - 20 Aug 2018


  • accident & emergency medicine
  • airway management
  • medical education & training
  • tracheostomy

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