A new strategy for difficult airway management with visual needle cricothyroidotomy: a manikin study.

•A 0.9-mm microimaging fiber was delivered into a 14G needle to develop a visual puncture system.•This study used this visual puncture system to perform needle cricothyroidotomy.•To the best of our knowledge, this is the first experience to investigate the feasibility and efficiency of this video-assisted system for needle cricothyroidotomy in manikin.•Under visual guidance, the needle tip of this visual puncture system was delivered into the tracheal lumen with proper position. In comparison to the conventional group, due to visual guidance, this new strategy had less procedure time and procedure-related complications.•Moreover, the anatomy of both the upper and lower airways was acquired, which could provide useful information for diagnostic purposes. Therefore, visually guided needle cricothyroidotomy may be a new strategy for difficult airway management in future care.