The open cricothyrotomy technique is taught as the trauma airway standard when one “cannot intubate and cannot ventilate” however, it is not without difficulty and limitations. The B.A.C.T. (Bougie-AssistedCricothyrotomy Technique) may improve the procedure by using a bougie to assist.
Steps for the B.A.C.T. (as described in the paper): 1. Stabilize the larynx with the thumb and middle finger, then identify the cricothyroid membrane. 2. Make a transverse stabbing incision with a scalpel through both skin and cricothyroid membrane. 3. Insert tracheal hook at the inferior margin of the incision and pull up on the trachea. 4. Insert a bougie through the incision with curved tip directed towards the feet 5. Pass 6-0 endotracheal tube or Shiley over bougie into trachea.
Advantages of a bougie: 1. Thin and easy to insert into incision 2. Tactile feedback from tracheal rings confirms proper placement 3. Ensures that stoma will not be lost during procedure
EMRAP.tv has a great video of Dr. Darren Braude demonstrating the procedure; http://bit.ly/nB3BMG
References
Hill, C., et al. Cricothyrotomy Technique Using Gum Elastic Bougie Is Faster Than Standard Technique: A Study of Emergency Medicine Residents and Medical Students in an Animal Lab. Academic Emergency Medicine17(6), 666–669.
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