This chapter presents a case to demonstrate the dire situation of can't ventilate, can't intubate (CVCI) in a patient who cannot breathe. The cricothyroid membrane is composed of fibroelastic tissue bordered by the cricothyroid muscles laterally, thyroid cartilage superiorly, and cricoid ring inferiorly. The fundamental difference between cricothyroidotomy techniques is how the procedure is approached and how the airway lumen is entered: either by needle puncture or blade incision. Needle puncture techniques are based on equipment originally developed for vascular access. The rate and nature of the complications associated with a cricothyroidotomy depend on the choice of technique, skill level of the operator, and patient factors. Surgical cricothyroidotomy is also inadequate for long-term ventilation and is frequently converted to a formal tracheotomy. Simulation is an important component of training and instruction in airway management, especially cricothyroidotomy because it is seldom performed.

Loss of the airway is quite apparent once oxygen saturations begin to fall but identifying it before this happens gives more time for a definitive diagnosis to be made and for the correct course of action to be implemented. It is obviously preferable to maintain ventilation throughout a general anaesthetic rather than have to rescue a lost airway. An emergency situation only exists when all three routine methods of oxygenation (facemask, laryngeal mask and tracheal intubation) have failed. The cricothyroid membrane is the preferred site for emergency access to the trachea for oxygenation. There are three types of cricothyroidotomy: small cannula devices, large bore cannula devices, and surgical cricothyroidotomy. Accepting the diagnosis of a lost airway is a difficult mental process. The only thing that distinguishes the lost airway from other cases is that the anaesthetist's usual armamentarium of techniques does not restore ventilation.