Indications for Percutaneous Cricothyrotomy Apnea, severe respiratory failure, or impending respiratory arrest requiring endotracheal intubation and either Failed attempts at orotracheal or nasotracheal intubation with the inability to oxygenate or ventilate via alternate methods (eg, bag-valve-mask, supraglottic airway device) Contraindications to orotracheal or nasotracheal intubation such as massive oral hemorrhage, severe facial trauma, or mass effect due to tumor Contraindications to Percutaneous Cricothyrotomy Absolute contraindications Age < 8 years Relative contraindications Inability to identify landmarks due to significant injury to the larynx, thyroid cartilage, or cricoid cartilage Partial or complete transection of the distal trachea Age 8 to 12 (varying age cutoffs without definitive expert consensus) Complications of Percutaneous Cricothyrotomy Early complications, recognized immediately or within hours after cricothyrotomy, include the following: Bleeding, sometimes uncontrollable Insertion of tube into neck tissues rather than trachea, typically immediately recognized by absence of breath sounds on lung auscultation and remediated by reinsertion of tube into trachea Injury to or perforation of the posterior aspect of the trachea Larynx, vocal cord, or thyroid injury Late complications, recognized weeks or months after cricothyrotomy, include the following: Progressive airway obstruction due to subglottic stenosis and stomal granulation tissue Voice changes, which are chronic but may resolve with time Wound infection Equipment for Percutaneous Cricothyrotomy Antiseptic solution (eg, chlorhexidine, povidone-iodine) and sterile gauze Sterile drapes Sterile gloves and gowns along with eye and face protection (universal precautions) Local anesthetic (eg, 1% or 2% lidocaine with epinephrine, 25-gauge needle, 3-mL syringe) Catheter-over-the-needle device capable of accommodating a guidewire, attached to a 3 - to 6-mL syringe half-filled with saline Flexible guidewire in a plastic housing Airway catheter (tracheal tube) that has a plastic inflatable cuff and a removable intraluminal curved blunt dilator (which facilitates insertion) #15 scalpel blade Suction source and suction catheter Bag-valve-mask and oxygen source Patient monitoring equipment, including cardiac monitor, pulse oximeter, blood pressure monitor (noninvasive) Capnometer (end-tidal carbon dioxide monitor), if available Some commercially available kits contain all or some of these: airway catheter, guidewire, syringe, and catheter-over-needle device.