1. Sydney Clinical Skills and Simulation Centre Management of the Critically Obstructed Airway Session 1: Why is CICO a problem?

2. Is CICO rare?  Incidence 1:225,000 to 1:56,000  1:10-20,000 anaesthetics = CICO  Cases per year : 1500  20 year career : 20*1500= 30000 cases  Maybe...1 case of CICO in a career....  Not including those you are called to help out with YES, but it accounts for 25% of all anaesthesia related deaths

3. NAP4 What is NAP4?  Prospective audit of serious airway complications in the UK over one year death brain damage surgical airway unexpected ICU admission Results  2.9 million anaesthetic procedures  184 serious airway complications  133 anaesthesia-related (1: 22 000) 58 involved surgical airway attempt (1:50 000) 25 by the anaesthetist Only 9 successful!

4. Why is CICO a problem? It is an infrequently encountered life threatening problem that is sub-optimally managed

5. Elaine Bromiley

6. How is CICO poorly managed?  Not anticipated – 29% occur at end of anaesthesia or during recovery period  Inadequate supraglottic rescue  Unwillingness to stop supraglottic rescue and attempt infraglottic rescue  Disorganisation and lack of a cohesive plan  Lack of access to, or familiarity with equipment  Technical failure ‘Elements of poor planning, poor judgement, deviation from recognised algorithms and failures of technical skills were seen throughout the reports submitted to the project (NAP4)’

7.  Four cases, all CICO  In all cases no emergency surgical airway was attempted, or it was attempted too late  Authors propose explanation for failure to move beyond attempts at intubation and/or bag mask ventilation

8. 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