A patient who is impossible to mask ventilate and impossible to intubate (CICO scenario) after full RSI doses. The 'last resort' surgical airway is required. What is the FIRST-LINE method for emergency surgical airway in adults?
- A Emergency tracheostomy under local anaesthesia
- B Needle cricothyroidotomy with jet ventilation
- C Retrograde intubation over a guidewire
- D Scalpel-finger-bougie-tube (scalpel cricothyrotomy) technique ✓
Explanation
In the CICO scenario, current Difficult Airway Society (DAS 2015) and AAOHNS guidelines recommend the scalpel-finger-bougie-tube (scalpel cricothyroidotomy) technique as the first-line emergency surgical airway for adults. This technique: (1) makes a 8–10 mm transverse stab incision through the cricothyroid membrane; (2) dilates with a finger or tracheal hook; (3) passes a bougie anteriorly; (4) railroads a 6.0 cuffed ETT. It is faster and more reliable than needle jet ventilation, which has high failure rates (especially with soft tissue distortion) and risks barotrauma. Emergency tracheostomy is slower and requires more equipment.
Reference: Morgan & Mikhail's Clinical Anesthesiology, 6th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.