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. 
  Alfred Hospital (Melbourne, Australia) Adult CICO Rescue Kit   Needle Pack Contents: 14G Insyte cannula, 5ml syringe, 10ml 0.9% Saline, Rapid O2 insufflation device.   Scalpel Pack Contents: Size 10 scalpel, Frova intubating catheter, Size 6.0 cuffed ETT.

Alfred Hospital (Melbourne, Australia) Adult CICO Rescue Kit

Needle Pack Contents: 14G Insyte cannula, 5ml syringe, 10ml 0.9% Saline, Rapid O2 insufflation device. 

Scalpel Pack Contents: Size 10 scalpel, Frova intubating catheter, Size 6.0 cuffed ETT.

Cabrini Health (Melbourne, Australia) CICO Rescue Kits

Needle Kit contents: 14G Insyte IV cannula, 5ml luer lock syringe, 10ml 0.9% saline ampoule, RapidO2 insufflation device, operator guideline

Scalpel Kit contents: Size 10 broad blade disposable scalpel, Frova intubating catheter, Cook 15mm Rapifit connector, 6.0 cuffed ETT, 10ml syringe, green gauze, operator guideline

Epworth Health (Melbourne, Australia) CICO Rescue Kits

CICO Pack One (Needle) Contents: 14G Insyte cannula, 5ml syringe, 10ml 0.9% Saline, Rapid O2 insufflation device

CICO Pack Two (Scalpel) Contents: Size 10 broad blade disposable scalpel, Frova intubating catheter, Size 6.0 cuffed ETT

North Shore Private Hospital (Sydney, Australia) CICO Rescue Kit

Monash Health (Melbourne, Australia) CICO Rescue Kit

Cannula Kit Contents: 14G Insyte cannula, 5ml syringe, 10ml 0.9% Saline, Rapid O2 insufflation device.

Scalpel Kit: Size 10 broad blade disposable scalpel, Size 6.0 cuffed ETT, Frova intubating catheter, Cook 15mm Rapifit adaptor.

Additional: Restock instructions

  Monash Health (Melbourne, Australia) Paediatric CICO Rescue Kit   Cannula Kit Contents: 16G Insyte cannula, 5ml syringe, 10ml 0.9% Saline, Rapid O2 insufflation device.  Infant (<10kg) Scalpel Kit: Size 10 broad blade disposable scalpel, 5 Fr solid bougie, Size 3.0 microcuff ETT  Small Child (10-30kg) Scalpel Kit: Size 10 broad blade disposable scalpel, 8 Fr hollow bougie, Cook 15mm Rapifit adaptor, Size 4.0 microcuff ETT  Large Child (>30kg) Scalpel Kit: Size 10 broad blade disposable scalpel, 11 Fr hollow bougie, Size 5.0 microcuff ETT, Cook 15mm Rapifit adaptor  Additional: Restock instructions

Monash Health (Melbourne, Australia) Paediatric CICO Rescue Kit

Cannula Kit Contents: 16G Insyte cannula, 5ml syringe, 10ml 0.9% Saline, Rapid O2 insufflation device.

Infant (<10kg) Scalpel Kit: Size 10 broad blade disposable scalpel, 5 Fr solid bougie, Size 3.0 microcuff ETT

Small Child (10-30kg) Scalpel Kit: Size 10 broad blade disposable scalpel, 8 Fr hollow bougie, Cook 15mm Rapifit adaptor, Size 4.0 microcuff ETT

Large Child (>30kg) Scalpel Kit: Size 10 broad blade disposable scalpel, 11 Fr hollow bougie, Size 5.0 microcuff ETT, Cook 15mm Rapifit adaptor

Additional: Restock instructions

View a video about the Royal Children's Hospital (Melbourne, Australia) CICO Rescue Kit

Thanks to Ric Solís (@SolisREMDoc) for CICO Kit banner photo