Anaesthetists and surgeons reach agreement on front of neck emergency techniques in life-threatening ‘CICO’ situations

Royal College of Anaesthetists | Published online: 19 September 2016

A new research paper, jointly published today by the British Journal of Anaesthesia and Clinical Otolaryngology, recommends the scalpel-bougie cricothyroidotomy technique as the most efficient and reliable method of obtaining emergency front of neck access to the trachea in a situation where the patient’s airway is blocked and routine methods fail.

Without this rescue technique many of these patients would die. The technique, which involves placing a tube into the windpipe using a scalpel and a small guide, is recommended by a working group of anaesthetists and ear, nose and throat surgeons, led by the Royal College of Anaesthetists, which is working to spread this information to clinicians across the country.

Patients who are unconscious, either through illness or during anaesthesia, require a tube to be placed into the trachea to enable oxygen to reach the lungs. Although anaesthetists are able to manage the vast majority of difficult airways, some may rapidly develop into ‘can’t intubate, can’t oxygenate’ (CICO) events, which are one of the most feared emergencies in clinical medicine. These life-threatening situations, occurring  approximately 100 times per year in the UK, often take place after instances of failed airway management and, if not managed correctly will lead to death or brain damage from lack of oxygen.

Anaesthetists and surgeons must work quickly and collaboratively to place a tube in the front of the neck (a front of neck airway, FONA). Good team communication, correct choice of FONA techniques and timing of interventions are all critical to the survival of the patient suffering from life-threatening breathing problems.

Read the original article abstract here

Read the full RCA statement here

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