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Copyright (c) 2024 Muhammad Maaya, Ina Ismiarti Shariffuddin, Shahridan Mohd Fathil, Wan Aizat Wan Zakaria, Nadia Md Nor, Mohd Fahmi Lukman, Jie Cong Yeoh
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Abstract
The “cannot intubate, cannot oxygenate” (CICO) event is a very rare airway crisis. The ensuing airway management is time-sensitive and if not managed promptly, CICO can lead to hypoxic brain injury or death. The identification of the cricothyroid membrane may be challenging when under stress, especially in certain patients, such as those with obesity and short neck. Thus, airway ultrasonography can be a useful aid in identifying the membrane. The emergency front of neck access (eFONA) rescue is performed using various methods, including needle cannula cricothyrotomy, scalpel-bougie method, traditional open cricothyrotomy, or using a commercial kit. The 4th National Audit Project reported a 60% failure rate of needle cricothyrotomy when it was the first eFONA choice, compared to 100% success rate when surgical cricothyrotomy was selected as the first airway rescue method. Thus, the Difficult Airway Society’s recent guidelines recommend the scalpel-bougie technique. Apart from retaining the eFONA skills by training, education, and cognitive aids, patient safety can also be improved at the institutional administrative level by establishing airway equipment standardisation and a multidisciplinary airway management team.
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