Comparison between laryngeal handshake and palpation techniques in the identification of cricothyroid membrane: a meta-analysis


Because the use of conventional digital palpation technique for the identification of cricothyroid membrane (CTM) has been widely believed to be unreliable, the ‘laryngeal handshake’ technique (LH) has been introduced for CTM identification in the event of cricothyroidotomy. To provide evidence for clinical practice, this pilot meta-analysis aimed at investigating whether identification of CTM with the LH is superior to that with the palpation technique. Studies that evaluated the accuracy of CTM identification by using LH or palpation techniques (i.e., LH group vs. Palpation group) were identified from electronic databases including PubMed, Embase, Medline, google scholar, Cochrane Central Register of Controlled Trials from inception to July 5, 2020. The primary outcome was the accuracy of both techniques. Four studies published from 2018 to 2020 were considered relevant and were read in full. We found no significant difference in success rate of CTM identification [Risk Ratio (RR) 1.09, 95% CI 0.89–1.34, p = 0.41] between the two groups. These preliminary results of the current study demonstrated no significant differences in success rate between the laryngeal handshake and conventional palpation techniques in cricothyroid membrane identification.

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  1. 1.

    Levitan RM. Cricothyrotomy. Airway Cam—airway management education and training. Accessed 4 Aug 2015.

  2. 2.

    Frerk C, Mitchell VS, McNarry AF, Mendonca C, Bhagrath R, Patel A, O’Sullivan EP, Woodall NM, Ahmad I, Difficult Airway Society Intubation Guidelines Working Group. Difficult Airway Society 2015 guidelines for management of unanticipated difficult intubation in adults. Br J Anaesth. 2015;115:827–48.

    CAS  Article  Google Scholar 

  3. 3.

    Moore A, Curtis R, Umar M. A comparison of the laryngeal handshake method versus the traditional index finger palpation method in identifying the cricothyroid membrane, when performed by combat medic trainees. J Spec Oper Med. 2019;19:71–5.

    PubMed  Google Scholar 

  4. 4.

    Bowness J, Taylor A, Le Saint-Grant A, Dalton A, Crawley S, Chisholm F, Varsou O, Teoh WH, Kristensen M, McGuire B. Identifying the cricothyroid membrane: a comparison of palpation, laryngeal handshake and ultrasound. Trends Anaesth Crit Care. 2020;30:e56.

    Article  Google Scholar 

  5. 5.

    Drew T, McCaul C. Laryngeal handshake technique in locating the cricothyroid membrane: a non-randomised comparative study. Br J Anaesth. 2018;121:1173–8.

    CAS  Article  Google Scholar 

  6. 6.

    Oh H, Yoon S, Seo M, Oh E, Yoon H, Lee H, Lee J, Ryu HG. Utility of the laryngeal handshake method for identifying the cricothyroid membrane. Acta Anaesthesiol Scand. 2018;62:1223–8.

    CAS  Article  Google Scholar 

  7. 7.

    Wyeen KW, Masri SNNS, Yusof AM, Izaham A, Mahdi SNM, Nor NM. Accuracy of digital palpation and laryngeal handshake in identification of cricothyroid membrane: An observational study. Anaesth Pain Intensive Care. 2020;24:168–74.

    Article  Google Scholar 

  8. 8.

    Lang S, Kleijnen J. Quality assessment tools for observational studies: lack of consensus. Int J Evid Based Healthc. 2010;8:247.

    Article  Google Scholar 

  9. 9.

    Kristensen MS, Teoh WH, Rudolph SS. Ultrasonographic identification of the cricothyroid membrane: best evidence, techniques, and clinical impact. Br J Anaesth. 2016;117(Suppl 1):i39–48.

    Article  Google Scholar 

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Correspondence to Cheuk-Kwan Sun.

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Hung, KC., Lin, YT. & Sun, CK. Comparison between laryngeal handshake and palpation techniques in the identification of cricothyroid membrane: a meta-analysis. J Clin Monit Comput (2021).

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  • Laryngeal handshake
  • Cricothyroid membrane
  • Palpation technique
  • Cricothyroidotomy
  • Cricoid cartilage