A 'cannot intubate, cannot oxygenate' (CICO) scenario has developed. The anaesthetist attempts an emergency front-of-neck airway (eFONA). Which technique is currently preferred by DAS 2015 guidelines for the first attempt?
- A Percutaneous Seldinger cricothyroidotomy
- B Retrograde intubation via the cricothyroid membrane
- C Transtracheal jet ventilation via a 14G cannula
- D Scalpel-bougie-tube cricothyroidotomy (scalpel cricothyroidotomy) using a horizontal stab incision through the cricothyroid membrane ✓
Explanation
DAS 2015 and NAP4 guidelines recommend the scalpel-bougie-tube technique (scalpel cricothyroidotomy) as the first choice for eFONA in CICO scenarios. Steps: palpate or use ultrasound to identify CTM, make a horizontal (transverse) stab incision through the CTM with a scalpel blade, insert a tracheal hook or finger to stabilise the trachea, introduce a bougie through the incision, then railroad a cuffed 6.0 mm ETT over the bougie. Needle cricothyroidotomy with jet ventilation is associated with high failure and complication rates in adults and is no longer the primary recommendation. Time to oxygenation is critical — 'call for help, declare CICO, proceed without delay.'
Reference: Morgan & Mikhail's Clinical Anesthesiology, 6th ed.
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Written and medically reviewed by the StethoPrep medical team.