CICO in morbid obesity and anatomical distortion

Jan 08, 2026

CICO events are rare, but when they occur in patients with morbid obesity or altered neck anatomy, the challenge escalates quickly. In perianaesthesia, these patients are increasingly common. Understanding how body habitus and distorted anatomy affect airway rescue helps teams act earlier and more decisively.

Morbid obesity changes airway physiology. Reduced functional residual capacity means oxygen reserves are smaller and desaturation happens faster. Soft tissue bulk around the neck can obscure landmarks, limit neck extension, and make mask ventilation and supraglottic airway placement less effective. Anatomical distortion from tumours, previous surgery, radiotherapy, infection, or trauma further complicates both intubation and emergency front of neck access.

In a CICO situation, delay is dangerous. The eFONA guidance highlights that landmark identification can be unreliable in obesity and distorted anatomy, and that reliance on palpation alone may fail. Early declaration of CICO and a clear plan for emergency front of neck access are critical when oxygenation is deteriorating.

Key considerations include:
🔵Rapid desaturation is expected in morbid obesity
🔵Neck landmarks may be difficult or impossible to feel
🔵Early CICO declaration supports timely action
🔵Scalpel based eFONA techniques are more reliable than narrow bore cannulae
🔵Team role clarity reduces hesitation under pressure

For perianaesthesia nurses, preparation makes the difference. Anticipating difficulty, positioning patients optimally, knowing where airway rescue equipment is stored, and supporting early escalation all contribute to safer outcomes. Clear communication when oxygenation is failing helps the team move forward together.

Clinical insight: In obesity and anatomical distortion, CICO arrives faster and looks different. Acting early and prioritising oxygenation saves lives.

Build Knowledge ✅

Improve Safety ✅

References:
PerioperativeCPD. (2024). Emergency front of neck access (eFONA). https://www.perioperativecpd.com/wp-content/uploads/2024/03/eFONA.pdf

Stay connected with news and updates!

Join our mailing list to receive the latest news and updates from our team.
Don't worry, your information will not be shared.

We hate SPAM. We will never sell your information, for any reason.

Want to keep learning?

Want more content like this? Check out our premium membership for exclusive content. 

Click Here for Access

 

 

Join our mailing list for free weekly educational content.

 

By entering your details you consent to receiving amazing educational materials and updates about our products and events.