ICU · Airway management

Difficult Airway Algorithms (DAS / ASA / CICO) & Front-of-Neck Access

Also known as Difficult airway · Difficult airway algorithm · DAS guidelines · CICO · Can't intubate can't oxygenate · Front of neck access · FONA · Cricothyroidotomy · MACOCHA score · NAP4 · Physiologically difficult airway

A difficult airway is one where a trained operator struggles with mask ventilation, laryngoscopy, or intubation. In ICU the patient is often both anatomically difficult (LEMON, MACOCHA) and physiologically difficult (shock, hypoxia, acidosis), and cannot simply be woken up. The Difficult Airway Society 2018 ICU intubation guideline structures the response into a sequence of plans (A: laryngoscopy and bougie; B: second-generation supraglottic airway rescue; C: maintain oxygenation and wake if able; CICO: front-of-neck access). CICO — can't intubate, can't oxygenate — is the life-threatening emergency requiring decisive scalpel-bougie cricothyroidotomy. The NAP4 audit showed most major airway events are avoidable: plan, assess, limit attempts, use capnography, and do not delay front-of-neck access.