Can’t Intubate, Can’t Oxygenate (CICO) - Guidelines ...

Can’t Intubate, Can’t Oxygenate (CICO) - Guidelines for Crises in Anaesthesia

This is the last resort when all other attempts to oxygenate have failed.

❶ Check optimal airway management is in place and maintain anaesthesia: supply 100% oxygen either by tightly fitting facemask, supraglottic airway device or nasal high flow.

❷ Consider ONE final attempt at rescue oxygenation via upper airway if not already done.

❸ Declare CICO and call for help (additional staff and surgical airway expertise e.g. ENT, ICU).

❹ Call for airway rescue trolley and then cardiac arrest trolley.

❺ Give neuromuscular blocking drug now.

❻ Prepare for Front of Neck Access – FoNA (see Box B).

❼ Check that the patient is positioned with full neck extension.

❽ Operator position:

  • Right-handed operator stands on patient’s left hand side.

  • Left-handed operator stands on patient’s right hand side.

❾ Perform a ‘laryngeal handshake’ to identify the laryngeal anatomy.

❿ Perform FoNA using technique in Box C to intubate trachea via cricothyroid membrane. (If cricothyroid membrane cannot be identified, use technique in Box D).

⓫ Secure tube, continue to oxygenate patient and ensure adequate depth of anaesthesia.

By Association of Anaesthetists @

Quick Reference Handbook - Guidelines for crises in anaesthesia 

#CICO #Intubate #Intubation #Difficult #Anesthesiology #Anesthesia #Intraoperative #Checklist #Diagnosis #Management #Workup 
Contributed by

Dr. Gerald Diaz
Board Certified Internal Medicine Hospitalist, GrepMed Editor in Chief 🇵🇭 🇺🇸 - Sign up for an account to like, bookmark and upload images to contribute to our community platform. Follow us on IG: | Twitter:

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