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Updated: Feb 19, 2026
Guidelines for Elective Pediatric Fiberoptic Intubation
Published on: January 17, 2011
Management of pediatric 'cannot intubate, cannot oxygenate'
Yohei Okada1, Wataru Ishii1, Norio Sato2
1Department of Emergency and Critical Care Medicine Japanese Red Cross Society Kyoto Daini Hospital Kyoto Japan.
Insights
In pediatric "cannot intubate, cannot oxygenate" (CICO) emergencies, cricothyroidotomy can be difficult. Scalpel-finger-bougie tracheostomy is a viable alternative for emergent airway access.
Area of Science:
- Pediatric Emergency Medicine
- Airway Management
- Critical Care
Background:
- The
Observation:
- A 3-year-old boy presented with cardiac arrest due to airway obstruction, a
Findings:
- Percutaneous cannula cricothyroidotomy and scalpel cricothyroidotomy were anatomically challenging in this pediatric CICO case.
- Emergent tracheostomy using the scalpel-finger-bougie technique on the proximal trachea was performed.
Implications:
- This case underscores the difficulties of standard emergency airway procedures in pediatric CICO.
- The scalpel-finger-bougie tracheostomy technique offers a potentially life-saving alternative in challenging pediatric CICO scenarios.
- Anatomical considerations in pediatric airway emergencies necessitate a broader range of procedural options.
Case:
"Cannot intubate, cannot oxygenate" (CICO) is a rare, life-threatening situation. We describe a pediatric case of CICO and highlight some educational points.A 3-year-old boy who collapsed in the bathtub came to our emergency department. On admission, he went into cardiac arrest probably because of an airway obstruction. We judged his condition as CICO and carried out an emergent tracheostomy after several attempts to perform a cricothyroidotomy failed. We continued resuscitation; however, circulation did not return spontaneously.
Outcome:
The child died, and the autopsy showed an airway obstruction caused by idiopathic anaphylaxis or acquired angioedema.
Conclusion:
This case highlights that it can be anatomically difficult to perform a percutaneous cannula cricothyroidotomy and scalpel cricothyroidotomy safely in pediatric CICO cases. An emergent tracheostomy using the scalpel-finger-bougie technique on the proximal trachea should be considered in such cases.
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