Sydney Clinical Skillsand Simulation Centre

Can’t Intubate Can’t Oxygenate (CICO)

Management of the Critically Obstructed AirwaySession 8: Being prepared – A systems plan

A systems plan

Key points for anaesthesia departments

Create a brand Agree on an emergency algorithm including team roles Easily remembered approach to supraglottic rescue Ensure equipment is available Provide training preferably multi-professional and inter-

disciplinary Address systems readiness Have assistance ready when required

Decision-making

Provide a decision support prompt

Ensure all staff are familiar with it

Encourage appropriate assertiveness within the team so a CICO is declared clearly

Enable the decision to perform a infraglottic rescue to be made without delays

Protocols

Commit to a procedural algorithm for CICO

Provide guidance to team-members on their roles during a CICO event

Train with the algorithm

Use a reliable algorithm that everyone is familiar with

Equipment

Ensure equipment, staffing and communication enable the protocol to be completed

Equipment should be familiar, accessible, in good working order and regularly audited or checked

The CICO pack should contain only that equipment relevant to the CICO algorithm

‘CICO preparedness checklist’/Audit

The Royal Perth Hospital CICO kit

The Royal Perth Hospital CICO kit

Leroy (EO sterilised)

Rapifit connectors (EO sterilised)

ESA kit – Monash Health

Royal North Shore Hospital, Sydney

Assistance

Ensure expert help comes

Have a roster for airway experts (ICU, ENT etc.) Monitor patients in appropriate environments Be prepared to call early

Team competency – refer to handout

Competency statements for: Primary proceduralist Other senior medical staff All members of the team

Audit – refer to handout

Summary: Multidisciplinary clinical guidelines for routine care of at risk

patients An emergency action plan Equipment that is in good working order Training Audit process and register of critical events