“Can’t intubate can’t oxygenate” situation in an elective patient in suspected sarcoidosis: a case report
Anaesthetists and pulmonologists are well trained to follow the “can’t intubate, can’t oxygenate” (CICO) protocol but the procedure is rarely practised. This case report concerns an elective patient scheduled for endobronchial ultrasound bronchoscopy (EBUS) because of suspected sarcoidosis. Based on...
| Main Authors: | , , , |
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| Format: | Article |
| Language: | English |
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SMC MEDIA SRL
2023-09-01
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| Series: | European Journal of Case Reports in Internal Medicine |
| Subjects: | |
| Online Access: | https://www.ejcrim.com/index.php/EJCRIM/article/view/4088 |
| _version_ | 1797645439485345792 |
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| author | Veronica Gerli Eva Koetsier Nicola Ledingham Paolo Maino |
| author_facet | Veronica Gerli Eva Koetsier Nicola Ledingham Paolo Maino |
| author_sort | Veronica Gerli |
| collection | DOAJ |
| description | Anaesthetists and pulmonologists are well trained to follow the “can’t intubate, can’t oxygenate” (CICO) protocol but the procedure is rarely practised. This case report concerns an elective patient scheduled for endobronchial ultrasound bronchoscopy (EBUS) because of suspected sarcoidosis. Based on known medical history, anaesthesia for EBUS procedure was initiated with a laryngeal mask. The airway turned out to be difficult and the patient was not ventilable despite several efforts including curarization and orotracheal intubation. Rapid desaturation imposed to apply the CICO protocol with emergency cricothyroidotomy as extreme measure but also failed. 6-handed face mask ventilation was continued. Eventually, introduction of a microlaryngeal tube of the 3rd generation laryngeal mask, placed on the fibrescope, allowed endotracheal intubation. The patient fell into pulseless electrical activity, and the CICO protocol was started. Immediate cardiopulmonary resuscitation totally recovered vital functions. In the post-operative follow-up, no temporary or permanent cardiological and neurological sequels were found, but new medical history such as inconstant use of C-PAP (Continuous Positive Airway Pressure) and a significant weight gain since the last notable difficult intubation were uncovered, which explained the patient’s compromised airways. Had this information been available prior to the scheduled operation, it would have indicated awake intubation with a local anaesthesia of the oropharynx and appropriate sedation of the patient. |
| first_indexed | 2024-03-11T14:46:22Z |
| format | Article |
| id | doaj.art-83d149150c52434eaffd4fe2bf3e70f3 |
| institution | Directory Open Access Journal |
| issn | 2284-2594 |
| language | English |
| last_indexed | 2024-03-11T14:46:22Z |
| publishDate | 2023-09-01 |
| publisher | SMC MEDIA SRL |
| record_format | Article |
| series | European Journal of Case Reports in Internal Medicine |
| spelling | doaj.art-83d149150c52434eaffd4fe2bf3e70f32023-10-30T11:03:54ZengSMC MEDIA SRLEuropean Journal of Case Reports in Internal Medicine2284-25942023-09-0110.12890/2023_0040883623“Can’t intubate can’t oxygenate” situation in an elective patient in suspected sarcoidosis: a case reportVeronica Gerli0Eva Koetsier1Nicola Ledingham2Paolo Maino3Anaestesiology, Ospedale Regionale di Lugano - Civico e Italiano, Ente Ospedaliero cantonale, Lugano, SwitzerlandPain Management Center, Neurocenter of Southern Switzerland, Ente Ospedaliero cantonale, Lugano, Switzerland; Faculty of Biomedical Sciences, Università della Svizzera italiana, Lugano, SwitzerlandAnaestesiology, Ospedale Regionale di Lugano - Civico e Italiano, Ente Ospedaliero cantonale, Lugano, Switzerland; Faculty of Biomedical Sciences, Università della Svizzera italiana, Lugano, SwitzerlandAnaestesiology, Ospedale Regionale di Lugano - Civico e Italiano, Ente Ospedaliero cantonale, Lugano, Switzerland; Pain Management Center, Neurocenter of Southern Switzerland, Ente Ospedaliero cantonale, Lugano, Switzerland; Faculty of Biomedical Sciences, Università della Svizzera italiana, Lugano, SwitzerlandAnaesthetists and pulmonologists are well trained to follow the “can’t intubate, can’t oxygenate” (CICO) protocol but the procedure is rarely practised. This case report concerns an elective patient scheduled for endobronchial ultrasound bronchoscopy (EBUS) because of suspected sarcoidosis. Based on known medical history, anaesthesia for EBUS procedure was initiated with a laryngeal mask. The airway turned out to be difficult and the patient was not ventilable despite several efforts including curarization and orotracheal intubation. Rapid desaturation imposed to apply the CICO protocol with emergency cricothyroidotomy as extreme measure but also failed. 6-handed face mask ventilation was continued. Eventually, introduction of a microlaryngeal tube of the 3rd generation laryngeal mask, placed on the fibrescope, allowed endotracheal intubation. The patient fell into pulseless electrical activity, and the CICO protocol was started. Immediate cardiopulmonary resuscitation totally recovered vital functions. In the post-operative follow-up, no temporary or permanent cardiological and neurological sequels were found, but new medical history such as inconstant use of C-PAP (Continuous Positive Airway Pressure) and a significant weight gain since the last notable difficult intubation were uncovered, which explained the patient’s compromised airways. Had this information been available prior to the scheduled operation, it would have indicated awake intubation with a local anaesthesia of the oropharynx and appropriate sedation of the patient.https://www.ejcrim.com/index.php/EJCRIM/article/view/40883rd generation laryngeal maskcicocuraredifficult airway ventilationmicrolaryngeal tube |
| spellingShingle | Veronica Gerli Eva Koetsier Nicola Ledingham Paolo Maino “Can’t intubate can’t oxygenate” situation in an elective patient in suspected sarcoidosis: a case report European Journal of Case Reports in Internal Medicine 3rd generation laryngeal mask cico curare difficult airway ventilation microlaryngeal tube |
| title | “Can’t intubate can’t oxygenate” situation in an elective patient in suspected sarcoidosis: a case report |
| title_full | “Can’t intubate can’t oxygenate” situation in an elective patient in suspected sarcoidosis: a case report |
| title_fullStr | “Can’t intubate can’t oxygenate” situation in an elective patient in suspected sarcoidosis: a case report |
| title_full_unstemmed | “Can’t intubate can’t oxygenate” situation in an elective patient in suspected sarcoidosis: a case report |
| title_short | “Can’t intubate can’t oxygenate” situation in an elective patient in suspected sarcoidosis: a case report |
| title_sort | can t intubate can t oxygenate situation in an elective patient in suspected sarcoidosis a case report |
| topic | 3rd generation laryngeal mask cico curare difficult airway ventilation microlaryngeal tube |
| url | https://www.ejcrim.com/index.php/EJCRIM/article/view/4088 |
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