Doctors Gates: Why cricothyrotomy is the best site for emergency airway

You witness a choking incident in a restaurant. The Heimlich maneuver is unsuccessful at removing the food from the pharynx. The victim is having extreme difficulty breathing and starts to pass out. Where are you most likely to produce an emergency airway?

a.In the midline just superior to the hyoid bone
b.In the midline just inferior to the hyoid bone
c.At the laryngeal notch
d.At the junction between the thyroid cartilage and cricoid cartilage
e.At tracheal ring 2 to 3 below the cricoid cartilage

The answer is (d).

The food is most likely stuck in the laryngeal pharynx, so you must produce an alternative airway below the glottis, which reflexly closes.
Locations around the hyoid bone (answers a and b)and above the laryngeal notch (answer c)are above the blockage and would not get air into the lungs. The isthmus of the thyroid gland
generally lies in front of the second and third tracheal ring (answer e), and because it is so highly vascular, it is not an ideal location for an emergency airway.

An additional alternative location for an emergency airway would be the jugular notch, but is not preferred because of the occurrence of a thyroid ima artery below the isthmus, in a small percentage of the population.