In a 'cannot intubate, cannot oxygenate' (CICO) emergency scenario, which is the DEFINITIVE rescue technique according to the DAS (Difficult Airway Society) guidelines?
- A Repeated laryngoscopy attempts using different blades
- B Trans-tracheal jet ventilation (TTJV) as the primary choice
- C Laryngeal mask airway reinsertion with 100% O2
- D Urgent surgical cricothyroidotomy (scalpel-bougie-tube technique) ✓
Explanation
In a CICO emergency — defined as inability to maintain SpO2 ≥90% with any supraglottic device or mask, AND failed intubation — the DAS 2015 guidelines mandate immediate surgical front-of-neck access (FONA) via scalpel cricothyroidotomy (scalpel-finger-bougie-tube technique). This is the only reliably life-saving technique in total airway obstruction. Repeated laryngoscopy wastes critical time. Trans-tracheal jet ventilation is no longer recommended as first-line FONA because of complications (barotrauma, surgical emphysema) and limited skill retention. LMA reinsertion may temporise but is not definitive in true CICO.
Reference: Morgan & Mikhail's Clinical Anesthesiology, 6th ed.
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Written and medically reviewed by the StethoPrep medical team.