Accuracy of identifying the cricothyroid membrane in children using palpation

Basaran B., Egilmez A. I., Alatas N., ANKAY YILBAŞ A., Sargin M.

JOURNAL OF ANESTHESIA, vol.32, no.5, pp.768-773, 2018 (SCI-Expanded) identifier identifier identifier

  • Publication Type: Article / Article
  • Volume: 32 Issue: 5
  • Publication Date: 2018
  • Doi Number: 10.1007/s00540-018-2538-0
  • Journal Indexes: Science Citation Index Expanded (SCI-EXPANDED), Scopus
  • Page Numbers: pp.768-773
  • Hacettepe University Affiliated: Yes


Accurate identification of the cricothyroid membrane (CTM) has paramount importance in the event of a 'cannot intubate, cannot oxygenate' scenario. We sought to determine the ability of anesthesiologists to correctly identify the CTM in obese and non-obese children. Anesthesiologists were asked to mark the entry point of the cricothyroidotomy device with an ultraviolet invisible pen on obese and non-obese (BMI <95th percentile for age and sex) children aged 7-12 years. A correct estimation was defined as a mark made between the upper and lower borders of the CTM and within the 3-mm midline. Twenty anesthesiologists palpated 30 obese and 50 non-obese children. The CTM was accurately identified with digital palpation in a total 55% of children, and there were no differences inaccurate identification rates of the CTM between obese and non-obese children [57 vs. 54%, respectively; median difference 3%; 95% confidence interval (-20 to 25%); p = 0.82]. Accuracy was not correlated with any demographic or morphometric features of the children. Percutaneous identification of the CTM in children aged 7-12 years was poor and not significantly different for obese and non-obese children. Pre-procedural ultrasonography may help to identify the landmarks for cricothyroidotomy.