CICO: Role Allocation

airway management cico closed loop communication patient safety Aug 08, 2024

A CICO event is high-stakes and chaotic. โš ๏ธ Having a shared mental model is proven to improve team performance by reducing fixation error, improving communication ๐Ÿ—ฃ๏ธ, and increasing the willingness to act. ๐Ÿ’ช

Have you thought about what your role might be during a CICO event? ๐Ÿค” It helps to take a step back and understand the tasks involved in performing CICO rescue, and the sequence in which they may occur. ๐Ÿ”„

It is likely that the primary anaesthetist or first responding anaesthetist will perform CICO rescue. Which means that the anaesthetic nurse has plenty to do. ๐Ÿƒ‍โ™‚๏ธ

Here’s our guide using the 4 Ps:

Prepare equipment ๐Ÿ› ๏ธ

  • Once the operator has been nominated, confirm which technique they will use first (cannula or scalpel) โœ…
  • Prepare the equipment during CICO status SET, and have it ready next to the patient. (See our CS articles on cannula and scalpel technique). ๐Ÿ“‹
  • Clean the neck with an alcohol swab. ๐Ÿงผ

Position the patient ๐Ÿ›๏ธ

  • When it is time to perform CICO rescue, stand at the head of the bed and extend the neck by pulling the chin up. ๐Ÿ™†‍โ™‚๏ธ
  • You may need to lower the head slightly from the original intubating position. ๐Ÿ”ฝ

Protect the lungs ๐Ÿซ

  • Delivery of jet ventilation via a cannula can cause dangerous barotrauma if there is no outlet for the oxygen to escape โš ๏ธ
  • You can reduce this risk by placing an oropharyngeal airway or LMA while cannula CICO rescue occurs. ๐Ÿšจ

Plan ahead ๐Ÿ—“๏ธ

  • The anaesthetist will be distracted by the high-stakes procedure, so it’s your role to plan ahead for the team. ๐Ÿ”
  • Always ask, “what might we need next”: ๐Ÿ’ฌ
    • Allocate someone to prepare the scalpel kit ๐Ÿ—ก๏ธ
    • Consider calling a surgeon who can perform a tracheostomy ๐Ÿ“ž
    • Call for a second anaesthetist if needed ๐Ÿ‘ฉ‍โš•๏ธ
    • Allocate someone to keep the patient sedated and paralysed ๐Ÿ’ค
    • Ensure the circuit is ready to connect with oxygen running โ™ป๏ธ
    • Source a bronchoscope for troubleshooting ๐Ÿ”Ž

 

Build knowledge โœ… 

Improve safety โœ…

Ref: Dr. Jack Madden, Periop Concepts. Advanced Anaesthesia Live Series 16: Can’t Intubate, Can’t Oxygenate 2024. www.periopconcepts.com

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