Landmark Versus Ultrasound-Guided Identification of the Cricothyroid Membrane: A Randomized, Prospective Trial

Document Type

Article

Publication Date

8-2026

Institution/Department

Emergency Medicine

Journal Title

The Journal of emergency medicine

MeSH Headings

Humans; Female; Prospective Studies; Middle Aged; Adult; Cricoid Cartilage (diagnostic imaging, anatomy & histology); Male; Thyroid Cartilage (diagnostic imaging, anatomy & histology); Ultrasonography (methods, standards); Aged; Ultrasonography, Interventional (methods, standards); Palpation (methods); Tomography, X-Ray Computed (methods); Emergency Service, Hospital (organization & administration); Anatomic Landmarks

Abstract

BACKGROUND: Airway emergencies and respiratory failure represent a frequent reason for Emergency Department (ED) visits. Surgical cricothyrotomy is a critical, time-sensitive procedure, infrequently performed and therefore at risk for complications. Correct identification of the cricothyroid membrane (CTM) has been demonstrated to be reliable and reproducible using point-of-care ultrasound in emergent airway cases. OBJECTIVES: This study assessed CTM identification accuracy comparing traditional landmark palpation and point-of-care ultrasound-guided visualization with neck computed tomography (CT) as the reference standard. METHODS: A prospective randomized study was performed at a university-based tertiary care center. Adult patients receiving a CT of the neck were identified through the electronic health record. CTM identification through landmark or ultrasound was performed by emergency physicians following randomization. Once identified, a 1.5 mm radiopaque metallic pellet sticker was placed over the site. A neuroradiology fellow or attending blinded to placement technique of the marker measured the distance between the marker on CT and the midpoint of the CTM. Correct placement was defined as the marker being within a 5 mm distance radially of the CTM midpoint. RESULTS/FINDINGS: Sixty-seven patients were enrolled, 31 were randomized to ultrasound-guided and 36 to landmark techniques. The mean age was 54.7 ± 18.2 years, 38 (56.7%) were female. The median body mass index (BMI) was 26.7 (IQR 18.3-35.1); the median BMI for the ultrasound group was 28.5 (IQR 19.5-37.5) and 26.6 (IQR 19.3-33.9) for the landmark group. 37 (55%) had the pellet within 5 mm of the center point of the CTM, with 16/31 (51.6%) accurately placed by ultrasound and 21/36 (58%) accurately placed by landmark (p = 0.63). CONCLUSION: No significant difference in accuracy was found between landmark- or ultrasound-guided identification of the cricothyroid membrane in the current cohort. Future studies should focus on patients selected for higher BMI, where palpation may be challenging.

ISSN

0736-4679

First Page

279

Last Page

286

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