When is cricothyrotomy indicated?

• A. After failure of LMA as the last step.
• B. In all trauma patients regardless of airway status.
• C. Only after failure of noninvasive methods.
• D. In a cannot-ventilate cannot-intubate emergency where noninvasive methods fail or are unavailable.

Answer: (D)

In an emergency airway, you move to a surgical airway when you cannot ventilate and cannot intubate, and you need rapid access to the trachea. Cricothyrotomy provides that direct airway through the cricothyroid membrane, allowing ventilation when other methods won’t work. Therefore, the indication is a cannot-ventilate cannot-intubate emergency in which noninvasive methods have failed or are unavailable. The other scenarios aren’t the same: you wouldn’t jump to a surgical airway after a single failed LMA if you can still ventilate, and it isn’t indicated for all trauma patients regardless of airway status. The key idea is the urgent, rescue airway in a cannot-ventilate cannot-intubate crisis when noninvasive options fail or can’t be used.