Just Added!

New Videos with Amal Mattu, MD

Watch NowGo

Bystander Cric With a Ballpoint Pen

December 26, 2016

Short Attention Span Summary

This is so wrong.
I thought you might like a more lighthearted article the day after Christmas.  So here goes!  Can bystanders with no or minimal anatomic knowledge perform an emergency cricothyrotomy with a pocket knife and ballpoint pen?  Turns out they were able to 80% (8/10) of the time on cadavers, 5 crics and 3 inadvertent trachs, with no vascular or esophageal injuries.  Problem is, it took an average of 243 seconds…yes, that’s over 4 minutes.  Also, cadavers don’t bleed.  The authors conclude that basic anterior neck anatomy and incision techniques should be included in CPR courses.  Ummm…no.

Spoon Feed
You might be able to do an emergency cric with a pocket knife and ballpoint pen.  But an untrained bystander will certainly not do well with this in a real patient that actually bleeds, at least not fast enough to save a life.  Probably best to focus on proven treatments for choking and high-quality CPR.


Resuscitation. 2016 Nov 1;110:37-41. doi: 10.1016/j.resuscitation.2016.10.015. [Epub ahead of print]

Bystander cricothyroidotomy with household devices – A fresh cadaveric feasibility study.

Braun C1, Kisser U2, Huber A2, Stelter K3.

Author information:

1Institute of Legal Medicine and Forensic Sciences, Ludwig-Maximilians-Universität, Munich, Germany.

2Department of Head and Neck Surgery, Ludwig-Maximilians-Universität, Munich, Germany.

3HNO Zentrum Mangfall-Inn, Rosenheim, Germany. Electronic address: Klaus.stelter@med.uni-muenchen.de.



In various motion pictures, medical TV shows and internet chatrooms, non-medical devices were presented as tools for life-saving cricothyroidotomies. However, there is uncertainty about whether it is possible for a bystander to perform a cricothyroidotomy and maintain gas exchange using improvised household items. This study examines the ability of bystanders to carry out an emergency cricothyroidotomy in fresh human cadavers using only a pocket knife and a ballpoint pen.


Two commonly available pens and five different pocket knives were used. Ten participants with no or only basic anatomical knowledge had to choose one of the pens and one of the knives and were asked to perform a cricothyroidotomy as quickly as possible after a short introduction. Primary successful outcome was a correct placement of the pen barrel and was determined by the thoracic lifting in a mouth-to-pen resuscitation.


Eight (80%) participants performed a successful approach to the upper airway with a thoracic lifting at the end. Five participants performed a cricothyroidotomy and three performed an unintentional tracheotomy. Injuries to muscles and cartilage were common, but no major vascular damage was seen in the post-procedural autopsy. However, mean time in the successful group was 243s.


In this cadaveric model, bystanders with variable medical knowledge were able to establish an emergency cricothyroidotomy in 80% of the cases only using a pocketknife and a ballpoint pen. No major complications (particularly injuries of arterial blood vessels or the oesophagus) occurred. Although a pocket knife and ballpoint pen cricothyroidotomy seem a very extreme procedure for a bystander, the results of our study suggest that it is a feasible option in an extreme scenario. For a better outcome, the anatomical landmarks of the neck and the incision techniques should be taught in emergency courses.

Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

PMID: 27810460 [PubMed – as supplied by publisher]

What are your thoughts?