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 @ https://twitter.com/AAGBI
Quick Reference Handbook - Guidelines for crises in anaesthesia
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