Failed intubation and failed oxygenation in a child.

Area of Science:

• Anesthesiology
• Pediatrics
• Genetics

Background:

• The 'can't intubate, can't oxygenate' (CICO) scenario is a rare but critical airway emergency in pediatric anesthesia.
• Fibrodysplasia ossificans progressiva (FOP) is a rare genetic disorder characterized by progressive heterotopic ossification, potentially impacting airway management.

Observation:

• A 4-year-old boy with FOP presented for jaw manipulation, with a preoperatively identified difficult airway.
• Despite preparation, a catastrophic loss of airway control occurred post-induction of general anesthesia.
• An emergency tracheostomy was required to secure the airway and preserve life.

Findings:

• This case represents an extremely rare pediatric CICO event.
• The management highlights the limited evidence and lack of definitive algorithms for pediatric CICO rescue.
• Immediate surgical airway intervention may be optimal in pediatric CICO situations due to anatomical factors.

Implications:

• This case underscores the challenges of managing rare genetic disorders in pediatric anesthesia.
• It emphasizes the critical need for advanced airway management training and preparedness for pediatric emergencies.
• Developing clear algorithms for pediatric CICO scenarios is crucial for improving patient outcomes and safety.