In the stressful and time-critical circumstance of a CICO event, difficulties with otherwise simple tasks such as recalling, articulating or locating equipment may hinder the timely initiation of CICO Rescue. To help overcome these challenges and facilitate access to dedicated equipment, it is recommended that pre-packaged CICO Rescue kits be immediately available in all locations where advanced airway management might potentially occur. The exact composition of such kits should be determined according to local policy and preferences but consideration of the following principles is recommended:
Kits should be constructed with attention to the available evidence for effectiveness and safety of different techniques. In particular a clear understanding of the equipment and technique requirements for safe performance of oxygen insufflation when using a cannula CICO Rescue technique should be understood (more information on this is available here).
Kits should be constructed in consultation with the clinicians who will use them so as to incorporate their preferences. Effectiveness of a CICO Rescue technique is dependent not only on its likelihood of technical success but also on a clinicians willingness to implement it.
- Equipment should be available for both cannula and scalpel based CICO Rescue techniques so that the appropriate choice can be made according to context and individual clinician preference.
- Equipment for a cannula technique for CICO Rescue must include an oxygen insufflation device that allows expiration via the cannula. This is not possible using a Manujet or 3-way tap device unless the they are disconnected from the cannula (which risks it becoming dislodged). Insufflation devices that permit expiration via the cannula include the Rapid O2, Ventrain, Enk Oxygen Flow Modulator as well as intermittent application of oxygen tubing to the cannula followed by its removal between each insufflation (again this latter technique increases the risk of dislodging the cannula).
- All clinicians (both medical staff and airway assistants) should be trained to ensure competence in the use of the kits.
- Transparent packaging of kits permits examination of the contents without needing to open them. This allows clinicians to familiarise themselves with the contents at any time. Additionally, in the context of an evolving airway emergency when CICO Status is escalated to READY, it provides the opportunity for the allocated clinician to confirm availability of the desired equipment and mentally rehearse the procedure.
- Use of cheap, readily available components rather than reliance on specialised kits makes ubiquitous access to CICO Rescue equipment more cost effective. In addition it allows for easier standardisation of equipment whilst retaining maximum flexibility in technique so as to allow individual clinicians to use a single consistent CICO Rescue technique across sites.