“Can’t intubate can’t oxygenate” situation in an elective patient in suspected sarcoidosis: a case report

Anaesthetists and pulmonologists are well trained to follow the “can’t intubate, can’t oxygenate” (CICO) protocol but procedure is rarely practised. This case report concerns an elective patient scheduled for endobronchial ultrasound bronchoscopy (EBUS) because of suspected sarcoidosis. Based on known medical history, anaesthesia EBUS was initiated with a laryngeal mask. The airway turned out be difficult not ventilable despite several efforts including curarization orotracheal intubation. Rapid desaturation imposed apply CICO emergency cricothyroidotomy as extreme measure also failed. 6-handed face mask ventilation continued. Eventually, introduction microlaryngeal tube 3rd generation mask, placed fibrescope, allowed endotracheal fell into pulseless electrical activity, started. Immediate cardiopulmonary resuscitation totally recovered vital functions. In post-operative follow-up, no temporary or permanent cardiological neurological sequels were found, new history such inconstant use C-PAP (Continuous Positive Airway Pressure) significant weight gain since last notable intubation uncovered, which explained patient’s compromised airways. Had this information been available prior operation, it would have indicated awake local oropharynx appropriate sedation patient.