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