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 #CICO #Checklist #Cannot #Intubate #Oxygenate #Mnemonic #Management #CriticalCare
