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Updated: Jan 24, 2026

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The OxyTain Algorithm: An Approach to Airway Management in the Cannot Intubate and Cannot Oxygenate Scenario.

Samuel A Schechtman1, Michael Buist, Benjamin H Cloyd

  • 1From the Department of Anesthesiology, Michigan Medicine - University of Michigan Medical School, Ann Arbor, Michigan.

A&A Practice
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Summary

Cannot intubate and cannot oxygenate events require advanced airway management. The OxyTain algorithm, using cannula cricothyroidotomy and scalpel bougie techniques, optimizes procedural success for emergency oxygenation.

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Area of Science:

  • Emergency Medicine
  • Anesthesiology
  • Surgical Procedures

Background:

  • Cannot intubate and cannot oxygenate (CICO) events represent critical airway emergencies.
  • Effective management of CICO events is essential for patient survival and preventing hypoxia.
  • Standardized algorithms and equipment are crucial for successful front-of-neck access (FONA) procedures.

Purpose of the Study:

  • To introduce and describe the OxyTain algorithm for managing CICO events.
  • To highlight the importance of standardized protocols and training in FONA.
  • To present a structured approach for optimizing procedural success in emergency airway management.

Main Methods:

  • Development and implementation of the institutional OxyTain algorithm.
  • Standardization of equipment for cannula cricothyroidotomy and scalpel bougie techniques.
  • Routine training of anesthesia providers on the algorithmic approach and FONA techniques.

Main Results:

  • The OxyTain algorithm aligns specific FONA techniques as primary and secondary interventions.
  • Standardized equipment and routine training aim to improve the success rate of emergency airway procedures.
  • The protocol is designed to ensure adequate oxygenation during challenging CICO events.

Conclusions:

  • The OxyTain algorithm offers a structured approach to managing CICO events.
  • Proper implementation, including standardized equipment and training, can optimize procedural success.
  • This algorithmic strategy has the potential to enhance patient outcomes in critical airway scenarios.