In the ASA Difficult Airway Algorithm, the 'cannot intubate, cannot oxygenate' (CICO) emergency pathway mandates which immediate intervention as the primary surgical airway strategy?

• A Emergency tracheostomy by surgical team
• B Needle cricothyrotomy with high-pressure jet ventilation
• C Retrograde wire-guided intubation
• D Front-of-neck access (FONA) by scalpel-bougie-tube technique (cricothyrotomy) ✓

Explanation

In the CICO scenario (failed intubation, failed oxygenation, failed supraglottic airway) the immediately life-saving intervention per DAS 2015 and ASA guidelines is cricothyrotomy (front-of-neck access). The scalpel-finger-bougie (scalpel-FONA) technique is favoured over needle cricothyrotomy because it provides a definitive airway in seconds without the risk of high-pressure barotrauma or catheter kinking. Needle jet ventilation can buy time but is not a definitive rescue. Tracheostomy is too time-consuming in a CICO emergency.

Reference: Morgan & Mikhail's Clinical Anesthesiology, 6th ed.

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Written and medically reviewed by the StethoPrep medical team.