Accuracy of identifying the cricothyroid membrane in children using palpation

Betul Basaran, Ayse Ilksen Egilmez, Necat Alatas, Aysun Ankay Yilbas, Mehmet Sargin

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.