Best Ballpoint Pen for Emergency Cricothyroidotomy?

I recently blogged about a man who choked to death on an airplane and the impossibility of saving this man's life with a surgical airway like a cricothyroidotomy without a sharp object around inside the plane (ie, knife or scalpel).

I also stated that "Some surgeons would argue a strong, stiff ball-point pen could have been used to perform the cricothyroidotomy, but as someone who has performed a dozen emergency cricothyroidotomies and tracheotomies in the past, even under the best of circumstances with a knife and being on a hospital floor with help around, it is hard. Furthermore, skin and the windpipe is made of tough 'fabric' and trying to punch a ball-point pen through is laughable. Try doing it yourself on a chicken with the skin on."

Well... it got me thinking... Let's assume for argument's sake that it IS possible to perform a cricothyroidotomy by literally punching through with a stiff ball-point pen into the airway. Would it actually work???


Believe it or not, there are two studies (listed below) I was able to find that tried to answer that very question. Contrary to popular belief... even IF a ball-point pen is able to secure an airway, the majority were found to be unsuitable due to inadequate internal diameter with too high an airway resistance for breathing.

In fact, the only TWO pens that might work (from a breathing standpoint) are the:

Baron retractable ballpoint

BIC soft feel Jumbo

I can't even find these items on Amazon.com.

A sports bottle straw apparently works better than a pen.

Reference:
Bystander cricothyroidotomy performed with an improvised airway. Mil Med. 2002 Jan;167(1):76-8.

Airflow efficacy of ballpoint pen tubes: a consideration for use in bystander cricothyrotomy. Emerg Med J. 2010 Apr;27(4):317-20.