Can't intubate, can't oxygenate (CICO)
This is the last resort when all other attempts to oxygenate have failed.
START.
1
Optimal airway management
2
Final attempt
3
Declare CICO
4
Equipment
5
Neuromuscular blockade
6
Prepare FoNA
7
Position
8
Operator position
9
Laryngeal handshake
10
Perform FoNA
11
Secure tube
Box A CRITICAL CHANGES
Cardiac arrest → 2-1
Box B EQUIPMENT INSTRUCTIONS
Airway rescue trolley, FoNA drawer:
Scalpel with number 10 blade
Bougie with coudé (angled) tip
Tracheal tube, cuffed, 6 mm
Box C STAB, TWIST, BOUGIE, TUBE TECHNIQUE
Identify the cricothyroid membrane (if unable, go to Box D).
Single transverse incision through skin and membrane.
Rotate scalpel 90° with sharp edge facing caudally.
Slide angled tip of bougie past the scalpel into the trachea.
Railroad tube over bougie.
Box D IF BOX C FAILS — SCALPEL, FINGER, BOUGIE TECHNIQUE
Make an 8–10 cm vertical incision head to toe orientation.
Use blunt dissection to retract tissue to identify trachea.
Stabilise the trachea and proceed as in Box C through the cricothyroid membrane.