Tension pneumothorax and contralateral presumed pneumothorax from endobronchial intubation via cricothyroidotomy.

Abstract

Cricothyroidotomy can be a life-saving procedure for the "can't intubate, can't ventilate" patient who has upper-airway obstruction. The procedure is usually fast and easy to do; however, complications have been reported. We report two cases in which cricothyroidotomy with an endotracheal tube led to unrecognized endobronchial intubation, ipsilateral tension pneumothorax, contralateral presumed pneumothorax, and unnecessary emergency surgery. Additionally, these led to the triad of hypotension, hypoxemia, and, probably, elevated intracranial pressure, which can worsen cerebral injury. We discuss methods to avoid these complications.