A CICO event is high-stakes and chaotic. ⚠️ Having a shared mental model is proven to improve team performance by reducing fixation error, improving communication 🗣️, and increasing the willingness to act. 💪
Have you thought about what your role might be during a CICO event? 🤔 It helps to take a step back and understand the tasks involved in performing CICO rescue, and the sequence in which they may occur. 🔄
It is likely that the primary anaesthetist or first responding anaesthetist will perform CICO rescue. Which means that the anaesthetic nurse has plenty to do. 🏃♂️
Here’s our guide using the 4 Ps:
Prepare equipment 🛠️
- Once the operator has been nominated, confirm which technique they will use first (cannula or scalpel) ✅
- Prepare the equipment during CICO status SET, and have it ready next to the patient. (See our CS articles on cannula and scalpel technique). 📋
- Clean the neck with an alcohol swab. 🧼
Position the patient 🛏️
- When it is time to perform CICO rescue, stand at the head of the bed and extend the neck by pulling the chin up. 🙆♂️
- You may need to lower the head slightly from the original intubating position. 🔽
Protect the lungs 🫁
- Delivery of jet ventilation via a cannula can cause dangerous barotrauma if there is no outlet for the oxygen to escape ⚠️
- You can reduce this risk by placing an oropharyngeal airway or LMA while cannula CICO rescue occurs. 🚨
Plan ahead 🗓️
- The anaesthetist will be distracted by the high-stakes procedure, so it’s your role to plan ahead for the team. 🔍
- Always ask, “what might we need next”: 💬
- Allocate someone to prepare the scalpel kit 🗡️
- Consider calling a surgeon who can perform a tracheostomy 📞
- Call for a second anaesthetist if needed 👩⚕️
- Allocate someone to keep the patient sedated and paralysed 💤
- Ensure the circuit is ready to connect with oxygen running ♻️
- Source a bronchoscope for troubleshooting 🔎
Build knowledge ✅
Improve safety ✅
Ref: Dr. Jack Madden, Periop Concepts. Advanced Anaesthesia Live Series 16: Can’t Intubate, Can’t Oxygenate 2024. www.periopconcepts.com
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