Have suction equipment available and ready.
Logroll the patient to the side, unless a spinal injury exists.
Deflate the pharyngeal cuff using the Number 1 pilot balloon.
Deflate the distal cuff using the Number 2 pilot balloon.
Gently remove the Combitube while suctioning the airway.
a. The establishment of an opening in the cricothyroid membrane is indicated for
relief of life-threatening upper airway obstruction when:
(1) Manual maneuvers (head-tilt-chin-lift, modified jaw-thrust) and attempts
at ventilation have failed.
Endotracheal intubation is not feasable due to:
(a) Unable to remove an upper airway foreign body airway obstruction
(b) Laryngeal or glottic edema (anaphylaxis, burns, etc.).
Maxillofacial trauma (distortion of landmarks).
Severe oropharyngeal hemorrhage.
b. Although creating a surgical opening in the cricothyroid membrane is a very
invasive procedure, its use may be necessary due to life threatening conditions.
Inability to establish an airway due to obstruction or other complication creates a
situation that requires quick thinking and rapid action. The surgical airway may be the
only viable option in this critical time.
Rapid, relatively safe procedure.
Patient experiences noticeably less CO2 retention because of better