According to the ASA Difficult Airway Algorithm, if a patient is classified as 'cannot intubate, cannot oxygenate' (CICO) and all attempts at supraglottic oxygenation have failed, the DEFINITIVE next step is:

• A Insert a second-generation supraglottic airway (ProSeal LMA) as a conduit for fibreoptic intubation
• B Administer sugammadex to reverse neuromuscular blockade and allow the patient to regain spontaneous ventilation
• C Attempt videolaryngoscopy with an Airtraq blade as a rescue technique
• D Perform emergency front-of-neck access (cricothyroidotomy or emergency tracheostomy) ✓

Explanation

In the CICO scenario — a true anaesthetic emergency — the priority is oxygenation by any means, and front-of-neck access (FONA) is the definitive emergency intervention. Techniques include needle cricothyroidotomy with jet ventilation (immediate but temporising), or surgical cricothyroidotomy (scalpel-bougie-tube technique), which is the preferred definitive FONA. Videolaryngoscopy and further intubation attempts are not appropriate when the patient is desaturating critically. Sugammadex reversal may be appropriate after FONA or as an adjunct to allow awakening if the situation permits, but it does not by itself secure the airway.

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

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.