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Sydney Clinical Skills and Simulation Centre Management of the Critically Obstructed Airway Session 2: Supraglottic Airway Rescue and Transition to Infraglottic Airway Rescue (Acknowledgements: adapted from talks by Dr Jamie Beit, Toowoomba), Helen Zois (Sydney) and Adam Rehak (Sydney)
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CICO Plan Part 1 Supraglottic Airway Rescue Part 1 Supraglottic Airway Rescue Part 2 Transition to CICO Part 2 Transition to CICO Part 3 Infraglottic Airway Rescue Part 3 Infraglottic Airway Rescue
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DAS summary flowchart
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Benumof JL, Dagg R, Benumof R (1997) Critical hemoglobin desaturation will occur before return to an unparalyzed state following 1 mg/kg intravenous succinylcholine. Anesthesiology 87: 979-82.
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The Vortex model Desaturation With permission Chrimes N & Fritz P 2013
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The Vortex model
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Surgical airway (Infraglottic rescue) Supraglottic Rescue The Vortex model
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Video
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Best attempt face-mask ventilation Optimal position (ear > sternum) Head tilt chin lift jaw thrust 2 handed BMV Second person ventilates High fresh gas flows (O 2 flush) Oro/Nasopharyngeal airway Cricoid off
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Best attempt endotracheal intubation Best person in room Best position (tragus >sternum) Best blade (e.g., videolaryngoscope) External laryngeal Manipulation (ELM) Bougie or stylet (only1 blind attempt) Consider muscle relaxant (if experienced) Cricoid off
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Best attempt LMA ventilation Different type (e.g. Proseal™) Different size Insert under direct vision) Insertion with jaw thrust Pull tongue forward Cricoid off Consider muscle relaxant (if experienced)
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There is no ideal number of attempts for face mask ventilation, endotracheal intubation or LMA ventilation. A best attempt: may involve >1 attempt is unlikely to be beneficial with >3 attempts How many attempts?
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Best attempt at: Face-mask ventilation? LMA ventilation? Endotracheal intubation? AND Oxygen saturations falling or persistently low? Is this a CICO situation? INFRAGLOTTIC RESCUE YES Continue Supraglottic rescue Consider waking patient Review again in 1 min Continue Supraglottic rescue Consider waking patient Review again in 1 min With permission A. Heard and Working group for the Rural Health Continuing Education (RHCE) (Stream 1) ‘Critically Obstructed Airway Workshop’. Contact smsc@nsccahs.health.nsw.gov.au. 2013smsc@nsccahs.health.nsw.gov.au NO TRANSITION ‘Transition’ protocol - CICO MOBILISE RESOURCES FOR CICO
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