Can’t Intubate Can’t Oxygenate (CICO)
During a failed airway, call CICO clearly once face-mask ventilation, supraglottic ventilation, and intubation have not restored oxygenation. Stop cycling through low-yield attempts and move the team toward prepared front-of-neck access while maintaining any oxygenation strategy that still buys time.
This LITFL update revisits the can’t intubate, can’t oxygenate pathway as a practical crisis framework rather than a rare theoretical endpoint. The key clinical point is that CICO is declared only after failure of the three upper-airway rescue options: face-mask ventilation, supraglottic airway ventilation, and tracheal intubation. Once oxygenation remains inadequate despite those attempts, the airway plan has to move quickly from repeated laryngoscopy toward emergency front-of-neck access. For ED teams, the value is less in introducing new evidence and more in reinforcing shared language, early recognition, and deliberate priming for FONA before saturations collapse. This is a useful checklist-style refresher for airway governance, simulation, and pre-briefing during anticipated difficult airways.