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Emergency airway puncture is insertion of a hollow needle into the airway done to treat life-threatening choking.

In an emergency situation, when someone is choking and all other efforts to assist with breathing have failed, a hollow needle or tube can be inserted into the throat, just below the Adam's apple (cricoid cartilage).

In a hospital setting, a small cut in the skin is made before inserting the needle.

A cricothyrotomy is recommended as an emergency procedure to relieve an airway obstruction until surgery can be done to place a breathing tube (tracheostomy).

Risks for any surgery are:

• Bleeding
• Infection

Additional risks include trauma to the voice box (larynx), thyroid gland, and esophagus, and perforation (tearing) of the lungs and other body parts in the chest, leading to a collapsed lung and air collecting around the heart.

Emergency airway puncture (cricothyrotomy) can be quite effective in temporarily relieving an airway obstruction, but it must quickly be replaced by a more effective means of ventilation.

What happens will depend on the cause of the airway obstruction and how quickly the person receives a better means of ventilation.

See: Tracheostomy

Needle cricothyrotomy

Goldenberg D, Bhatti N. Management of the impaired airway in the adult. In: Roberts JR, Hedges JR. Clinical Procedures in Emergency Medicine. 4th ed. Philadelphia, Pa: Saunders Elsevier; 2004: chap 106.

Rubin M, Sadovnikoff N. Pediatric airway management. In: Tintinalli JE, Kelen GD, Stapczynski JS, Ma OJ, Cline DM, eds. Emergency Medicine: A Comprehensive Study Guide. 6th ed. New York, NY: McGraw-Hill; 2004: chap 15.

Thomas SH, Brown DFM. Foreign bodies. In: Marx J. Rosen’s Emergency Medicine: Concepts and Clinical Practice. 6th ed. St. Louis, Mo: Mosby Elsevier; 2006: chap 57.

Updated by: Jacob L. Heller, MD, MHA, Emergency Medicine, Virginia Mason Medical Center, Seattle, WA. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.