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Can’t Intubate Can’t Oxygenate (CICO)

Can’t Intubate Can’t Oxygenate (CICO). Management of the Critically Obstructed Airway Session 8: Being prepared – A systems plan. A systems plan. Key points for anaesthesia departments Create a brand Agree on an emergency algorithm including team roles

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Can’t Intubate Can’t Oxygenate (CICO)

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  1. Can’t Intubate Can’t Oxygenate (CICO) Management of the Critically Obstructed Airway Session 8: Being prepared – A systems plan

  2. A systems plan Key points for anaesthesia departments • Create a brand • Agree on an emergency algorithm including team roles • Easily remembered approach to supraglottic rescue • Ensure equipment is available • Provide training preferably multi-professional and inter-disciplinary • Address systems readiness • Have assistance ready when required

  3. Decision-making Enable the decision to perform a infraglottic rescue to be made without delays • Provide a decision support prompt • Ensure all staff are familiar with it • Encourage appropriate assertiveness within the team so a CICO is declared clearly

  4. Protocols Use a reliable algorithm that everyone is familiar with • Commit to a procedural algorithm for CICO • Provide guidance to team-members on their roles during a CICO event • Train with the algorithm

  5. Equipment Ensure equipment, staffing and communication enable the protocol to be completed • Equipment should be familiar, accessible, in good working order and regularly audited or checked • The CICO pack should contain only that equipment relevant to the CICO algorithm • ‘CICO preparedness checklist’/Audit

  6. The Royal Perth Hospital CICO kit

  7. The Royal Perth Hospital CICO kit Leroy (EO sterilised)

  8. Rapifit connectors (EO sterilised)

  9. ESA kit – Monash Health

  10. Royal North Shore Hospital, Sydney

  11. Assistance Ensure expert help comes • Have a roster for airway experts (ICU, ENT etc.) • Monitor patients in appropriate environments • Be prepared to call early

  12. Team competency – refer to handout Competency statements for: • Primary proceduralist • Other senior medical staff • All members of the team

  13. Audit – refer to handout Summary: • Multidisciplinary clinical guidelines for routine care of at risk patients • An emergency action plan • Equipment that is in good working order • Training • Audit process and register of critical events

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