CICO Priming
airway emergency airway management cannula technique cico oxygenation patient safety scalpel technique Jul 29, 2024
Before the introduction of the Vortex Approach, we would have our 9 attempts at lifelines (3 attempts for each lifeline), or maybe even have more than that. Then someone would finally declare that we have a CICO situation 🚨. Then, reluctantly, the CICO equipment would be found, opened, prepared, and then a very stressed anaesthetist would perform CICO on a very blue patient 🫁🔵.
How could we do this better? 🤔
Instead of waiting for all 3 lifelines to fail, why not start preparing for CICO as the lifelines are lost? If we break up the priming into 3 stages, we can still keep things fairly simple.
Let’s call the 3 stages of priming: Ready, Set, Go.
1️⃣ When we lose our first lifeline, it should prompt the team to move to CICO status READY. This means you get the CICO kit out and ready to open 🎒
2️⃣ When you lose your second lifeline, you move to CICO Status SET. This means you open the package and set up the equipment ⚙️
3️⃣When you lose your third lifeline, you move to CICO Status GO, which means you perform CICO rescue 🚑.
By employing this priming technique, you do three essential things:
1️⃣ You have a shared mental model 🧠, where the whole anaesthetic team understands that as each lifeline is lost, the CICO status escalates 📈
2️⃣ You save vital seconds ⏳ when it’s finally time to declare CICO because your team is equipped and ready to go as soon as the third lifeline is lost.
3️⃣ You improve your team’s willingness to act 🏃♀️🏃♂️. Don’t underestimate the delays associated with fixation error and denial in this scenario!
Build knowledge ✅
Improve safety ✅
Ref: The Vortex Approach: vortexapproach.org
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