Can't Intubate, Can't Oxygenate (CICO)

🔑 Key Priorities

  • Recognise CICO early and declare emergency

  • Prioritise oxygenation over intubation

  • Initiate infraglottic rescue without delay

🧠 Team Actions

Role

Task

Team Leader

Declare CICO, direct transition to infraglottic rescue

Airway Operator

Attempt final FMV, prepare for surgical airway

Assistant

Position patient, landmarks, open CICO kit

Recorder

Log timeline, failed techniques, time of rescue

🧭 Management Algorithm

  1. Declare: "We are in a CICO situation"

  2. Final attempt at ventilation with best SGA or FMV

  3. Ensure full neuromuscular relaxation

  4. Initiate infraglottic airway procedure (operator-dependent):

    • Scalpel-bougie technique:

      • Horizontal stab at cricothyroid membrane

      • Rotate scalpel, insert bougie, railroad size 6 ETT

    • Cannula technique:

      • 14G cannula + saline-filled syringe

      • Connect to oxygen source (RapidO₂)

      • Deliver insufflation breaths

  5. Confirm chest rise or EtCO₂ response

  6. If failed: proceed with formal tracheostomy/cricothyrotomy

🔄 Ideal Crisis Flow

         Can’t Intubate, Can’t Oxygenate
                    ↓
       Final Optimised Supraglottic Attempt
                    ↓
       Declare CICO, Ensure Full Paralysis
                    ↓
         Perform Infraglottic Rescue
                    ↓
      Confirm Chest Rise / EtCO₂ Response

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