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Localisation of the cricothyroid membrane by digital palpation in the emergency department
  1. Hiba Alshareef1,
  2. Abdulaziz Al Saawi1,
  3. Faisal Almazroua1,
  4. Hadi Alyami1,
  5. Gerard O’ Reilly2,3,
  6. Biswadev Mitra2,3
  1. 1 Emergency Department, King Saud Medical City, Riyadh, Saudi Arabia
  2. 2 National Trauma Research Institute, The Alfred Hospital, Melbourne, Australia
  3. 3 Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Australia
  1. Correspondence to Dr Hiba Alshareef, Emergency Department, King Saud Medical City, Riyadh 11345, Saudi Arabia; hiba_alshareef{at}


Introduction A surgical approach to airway management may be essential in situations of difficult or failed airway, where immediate airway access is needed to provide oxygenation. However, the procedure is uncommonly performed and expertise among emergency clinicians may be limited.

Objectives The aim of this study was to assess the accuracy of cricothyroid membrane (CTM) identification by junior and senior emergency trainees by identification of surface anatomy landmarks. A secondary aim was to determine patient variables associated with accurate identification of CTM.

Methods A prospective observational study was conducted in a tertiary emergency department in the Kingdom of Saudi Arabia. Saudi Emergency Medicine board trainees participated in the study. Data were also obtained on gender and body habitus of patients. Junior trainees attempted to locate the membrane by palpation and marked it with an ultraviolet mark (blinded) pen followed by senior trainees. A certified ultrasound physician, also blinded to the trainee attempts, marked the membrane within a 5 mm circumference using a different coloured ultraviolet pen and was used as the reference gold standard.

Results There were 80 patients enrolled with junior and senior doctors assessing location for emergency cricothyrotomy. Proportion of correct localisation was 30% (95% CI 20% to 41%) among junior trainees and 33% (95% CI 22% to 44%) among seniors (P=0.73). Level of training, sex, height and weight of patients were not associated with success.

Conclusions Clinical localisation of CTM by emergency medicine trainees was poor even in non-stressful settings, and warrants further dedicated education and/or use of adjunct techniques.

  • airway management
  • tracheostomy
  • medical education & training
  • accident & emergency medicine

Statistics from


  • Contributors HiA, AA, GO and BM were involved in study design, analysis of results and write up. HiA, FA and HA assisted in recruitment of subjects and data collection.

  • Funding The KSMC-The Alfred International Trauma Program is funded by KSMC via the Ministry of Health (MOH) in the Kingdom of Saudi Arabia (KSA).

  • Competing interests None declared.

  • Patient consent Obtained.

  • Ethics approval King Saud Medical City institutional review board.

  • Provenance and peer review Not commissioned; internally peer reviewed.

  • Data sharing statement Primary data for this study can be provided in non-identifiable format by contacting the corresponding author​ ​and subject to approval by the IRB.​

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