Elective: Emergency Surgical Airway (Cricothyrotomy)
Elective adaptation of: Emergency surgical airway access through the cricothyroid membrane when standard intubation fails.
Indications
Failed airway after 3 intubation attempts, cannot intubate/cannot oxygenate situation.
Contraindications
No absolute contraindications when airway is truly unobtainable.
Equipment Required
Standard Equipment
Scalpel (no. 10 blade), bougie/dilator, cuffed tracheostomy tube (6.0mm) or small ETT, tape.
Lunar Medical Bay Substitutions
Standard plus: surgical airway kit must be pre-assembled and immediately accessible in crash cart. Practice with kit components before any elective airway management (in case needed). Headlamp for proper visualization (habitat lighting may be inadequate).
Procedure Steps
Identify cricothyroid membrane. Stabilize larynx. Horizontal incision through CTM. Dilate opening. Insert tube. Inflate cuff. Confirm with CO2 and BVM. Secure.
Lunar Technique Modifications (1/6 Gravity)
PATIENT POSITIONING: Neck in slight extension. Headring or support under shoulders to extend neck (in 1/6g, patient must be secured to prevent floating). Horizontal incision preferred (landmark-based). Bougie-assisted technique if available. This is a time-critical procedure — execute without hesitation if standard airway fails.
Telemedicine Guidance Points
Contact Earth Medical Relay (+1.3s delay) at these critical decision points:
Immediate notification. Video guidance if available during procedure. Post-procedure management guidance.
Training Requirements
Medical officers: surgical airway simulation minimum annually.
Possible Complications
Hemorrhage, false passage, subcutaneous emphysema, tube displacement.