As the Elaine Bromily case demonstrated, while it is essential to know how to perform a cricothyroidotomy, you also need to be aware of when to perform one. Rehearse in your mind at what stage of a failed intubation you would consider and perform an emergency cricothyriodotomy. Table 1 may help.
While many excellent courses are available to practice on manikins and cadavers, a simple empty plastic drinks bottle with some thick tape over it can suffice as a makeshift trachea for practice.
| Stage | Stage | Say | Do |
|---|---|---|---|
| Can't intubate after 3 attempts* | Ready | Declare "failed intubation" | Get the surgical FONA equipment |
| Failed SAD placement or failed FMV after 3 attempts* | Set | Declare "CICO" | Open the FONA equipment after one failed attempt each with FMV and SAD |
| CICO | Go | Emergency FONA | Perform scalpel-bougie cricothyroidotomy |
| SAD = Supraglottic airway device, FMV = Face-mask ventilation | |||
Table 1 Preparing and performing emergency cricothyroidotomy
*You don't need to have all 3 attempts. It might become clear after 1 attempt that you need to move to FONA.