Anesthesiology, critical care, and emergency medicine share the common goal of safe airway management. While often performed uneventfully, adverse patient anatomy, physiology, or situational acuity can precipitate an airway emergency. The outcome of an airway emergency may result as much from non-technical skills as from technical expertise.1-5 Airway guidelines now highlight the importance of these non-technical skills such as teamwork and effective communication during airway emergencies.6,7
One example of an airway emergency requiring timely and structured teamwork is the rare life-threatening ‘‘cannot intubate, cannot oxygenate’’ (CICO) emergency. The CICO emergency requires immediate transition from tracheal intubation attempts to an emergency front-of-neck airway (eFONA) procedure.6,A While often technically successful, eFONA is frequently performed too late to save the patient from hypoxemic brain damage or death.1,8 This delay may reflect the lack of a vital non-technical skill—i.e., establishing a shared mental model about what is occurring and initiating the predictable next steps required to remedy the CICO emergency.9 Lack of such a shared mental model may be related to: i) the failure to recognize a CICO emergency; ii) once recognized, the failure to promptly and unequivocally declare a CICO emergency to the entire team; and/or iii) once a CICO emergency is declared, the failure to rapidly perform eFONA. Cognitive aids, like checklists, appear to be more effective if they direct action rather than simply listing concerns.10 This article offers a simple mnemonic as a four-part cognitive aid—corresponding to the letters ‘‘CICO’’—that can be easily recalled and summarizes the key sequential steps to identifying and managing the CICO airway emergency
Conclusion
Heureusement, la gestion des voies ae´riennes est habituellement mene´e sans incident. Des difficulte´s peuvent toutefois survenir de manie`re inattendue et de´boucher sur des le´sions du cerveau par hypoxie ou sur un de´ce`s. Notre objectif est de renforcer la se´curite´ des patients et la compe´tence de l’e´quipe en cre´ant un mode`le mental partage´. La me´thode mne´motechnique cognitive de la CICO peut eˆtre utile, mais ne l’est que dans la mesure ou` l’e´quipe s’est re´gulie`rement entraıˆne´e a` faire face a` cette urgence des voies ae´riennes. Il faut rappeler que nous n’avons pas fourni de preuves empiriques que l’aide cognitive « CICO » ame´liore la communication, la performance ou les re´sultats. Nous pensons ne´anmoins qu’utilise´e comme aide cognitive, elle peut aider a` porter une plus grande attention a` l’urgence CICO en proposant une communication structure´e et un outil pour agir inde´pendamment de la spe´cialite´, de la profession ou de l’anciennete´ du membre de l’e´quipe. Nous pensons e´galement que ce format structure´ peut accroıˆtre la confiance, la cohe´sion et la performance de l’e´quipe au cours de la rare urgence d’une CICO.
