Abstract
Objective—To describe three dogs and two cats diagnosed with a cannot intubate, cannot oxygenate (CICO) condition, and discuss the appropriateness and timing of emergency front-of-neck airway access (eFONA). The authors aim to increase awareness of CICO events and effective management strategies, which may result in faster airway access and improve patient outcomes. Case series summary—Three dogs and two cats could not be easily intubated resulting in the inability to deliver oxygen and contributing to their death. Emergency front-of-neck airway access was attempted in three cases, it could not be performed in one when indicated, and it was not considered in managing another. Conclusions—This is the first report of small animals suffering CICO emergencies and tracheostomy attempts without a concurrently secured airway. Cannot intubate, cannot oxygenate events and eFONA attempts were managed sub-optimally in all cases, which likely contributed to the poor outcomes. Rapid diagnosis of CICO and early eFONA using appropriate techniques has the potential to improve the management of difficult airways in small animals.
Highlights
This report presents various examples of CICO in small animals, that all succumbed to their primary illness
It is probable that these animals would have benefited from timelier and more appropriate emergency front-ofneck airway access (eFONA)
Rapid diagnosis of CICO can be improved in veterinary medicine, where it should be recognized that airway obstruction is not the only indication for eFONA
Summary
Difficult airway management (DAM) encompasses a spectrum of clinical scenarios ranging from difficulty delivering oxygen to a patient with a face mask, to difficulty or inability to intubate the trachea [1]. The most severe end of the difficult airway spectrum is a cannot intubate, cannot oxygenate (CICO) scenario. This occurs when the trachea cannot be intubated resulting in inadequate oxygen delivery to tissues [2]. In this situation, the only treatment is surgical airway access, termed emergency front of neck airway access (eFONA), which restores oxygenation and ventilation [2]. The aim of this case series is to describe incidences consistent with CICO, using them as examples to demonstrate how proposed guidelines for diagnosis can prompt rapid recognition and early intervention
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