Using a concept similar to the Seldinger technique for vessel cannulation, a wire-guided cricothyrotomy approach can serve as a reliable and timely method for creating access to the airway in an otherwise dire situation. Compared with the conventional open tracheostomy approach to establishing an airway, wire-guided cricothyrotomy requires far less surgical skill and employs a wireexchange technique that is often familiar to nonsurgical practitioners. This method of establishing an airway in an emergency situation is accomplished by puncturing the cricothyroid membrane (CTM) with a thin-walled needle.¹ After aspiration of air confirms the location of the needle within the trachea, a wire is passed through the needle. The needle is subsequently withdrawn, leaving the wire in place. A small skin incision is made over the wire, which facilitates dilation and placement of an airway catheter into the trachea. Once inserted, the dilator is removed and the airway catheter is left seated within the airway. This sequence, known as the Seldinger technique, has been shown to reduce insertion-related complications, including cartilagenous injury and bleeding, and to increase rates of success for placement of an emergency airway.² Commercially available kits commonly used include the Melker Emergency Cricothyrotomy Kit and Arndt Emergency Cricothyrotomy Set (Cooke Critical Care, Bloomington, IN, USA).

Other percutaneous emergency cricothyrotomy sets use a catheter-over-needle technique, where wire insertion is not used to facilitate airway placement. Rather, an airway is placed directly into the trachea by threading it over a needle. Examples of these kits include the QuickTrach (VBM Medizintechnik GmbH, Sulz am Neckar, Germany) and the Patil Emergency Cricothyrotomy Catheter Set (Cooke Critical Care, Bloomington, IN, USA).

Many studies have evaluated the wire-guided technique in comparison with other accepted methods of emergently establishing an airway. Chan et al³ compared open surgical cricothyrotomy and the Melker wire-guided method, evaluating procedural success rates and practitioner technique preference. Nearly all (94%) of the participants preferred the wire-guided technique over open crithothyrotomy, and succes of airway placement was similar for both groups. Eisenburger et al⁴ conducted a study measuring the success and efficiency of open surgical cricothyrotomy against the wire-guided technique. No significant differences were found with regard to success rates, procedure time, or injury rates. Fikkers et al⁵ compared the wire-guided technique with the catheter-over-needle approach when performed by resident physicians. No significant difference was found between the two groups, as successful placement of an airway occurred in 85% and 95% of the attempts, respectively.

The limitations of this technique have been recognized, making proper patient selection and positioning paramount for optimizing successful completion of the procedure.⁶ Barkhuysen et al concluded that the wire-guided method for cricothyrotomy is not preferred in patients with severe maxillofacial trauma who rely on the prone or sitting position with anteflexion of the neck to maintain patency of the airway. Wire-guided cricothyrotomy has also been criticized as being more time intensive than other percutaneous approaches as there are multiple necessary steps for proper placement.⁷

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