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Simulation-based training bundle significantly reduces time to oxygen delivery via needle cricothyroidotomy in airway emergency
  1. Steven McVea,
  2. Thomas Bourke,
  3. Andrew Thompson,
  4. Christopher Flannigan
  1. Royal Belfast Hospital for Sick Children, Belfast, UK
  1. Correspondence to Dr Steven McVea, Royal Belfast Hospital for Sick Children, 180–184 Falls Road, Belfast BT12 6BE, UK; steven.mcvea{at}

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Needle cricothyroidotomy is a simple but potentially life-saving emergency airway manoeuvre used to provide oxygenation during a ‘cannot intubate, cannot ventilate’ (CICV) emergency.1 ,2 The procedure involves inserting a large bore cannula through the cricothyroid membrane and can be performed in patients of all ages.3 It is, however, only a short-term oxygenation solution prior to insertion of a definitive airway.1 The procedure is taught on Advanced Paediatric Life Support (APLS) courses where focus is on needle cricothyroidotomy insertion and not subsequent airway utilisation.3 This along with the rarity of this emergency means practical experience is lacking. Problems, such as equipment availability and poor assembly, would likely arise when the manoeuvre is required, which could be disastrous during this time-critical emergency. In this study, we show that introduction of a simulation-based training bundle improves:

  1. Successful simulated patient oxygenation

  2. Time taken to oxygenation

  3. APLS provider confidence


Invited APLS providers within a tertiary paediatric hospital were given the same hypothetical CICV scenario where a simulated patient has a needle cricothyroidotomy airway in situ. The project was registered with the local trust governance department. Candidates were asked, within a maximum time of 10 min, to collect and assemble suitable equipment to oxygenate or ventilate the patient.

Candidates were then shown a standardised video tutorial on needle cricothyroidotomy and introduced to a procedure pack containing all necessary equipment used within the …

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