Cannot Intubate, Cannot Oxygenate (CICO) Checklist Mnemonic 



C - Call it and communicate it: 

- Communicate explicitly, in an assertively graded manner: from "is this a CICO airway?" to "this is a CICO airway" 

- Call for help. Ask help received to summarize the situation they observe. 

I - Incision is Imminent: 

- Get equipment: a bougie, a 6.0 endotracheal tube and a N.10 or N.20 scalpel; 

- Paralyze the patient, make final attempts at face mask and supraglottic airway oxygenation while equipment is obtained and opened; 

C - Cut vertically: 

- Do not wait for surgical personnel to arrive. 

- Without delay, cut 4-6 cm vertically with the scalpel blade in the midline. Extend if required. 

- Palpate the cricothyroid membrane after vertical incision is made. 

O - Over-a-bougie technique: 

- Identify the cricothyroid membrane by palpation within the wound after skin and subcutaneous tissue incision; 

- Incise the cricothyroid membrane using a horizontal incision; 

- Maintain the opening with scalpel blade turned cephalad-caudad OR replace the scalpel blade with your finger; 

- Place a bougie through the cricothyroid membrane and downwards into the trachea; 

- Railroad a 6.0 cuffed endotracheal tube over the bougie into the trachea; inflate cuff; 

- Confirm endotracheal tube position with waveform capnography; 

- Re-oxygenate the patient; then suction the endotracheal tube for blood.



By Dr. Laura Duggan @drlauraduggan, Peter Brindley @docpgb, Dr. Adam Law



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