This podcast was originally published on March 1, 2015.
In this episode Kristin Lowrance, MSN, CRNA talks with Eric Carlson, CRNA about a case where he was called for a stat Cesarean section and after a rapid sequence induction, he could not intubate or oxygenate the patient. The case was at 2AM and Eric was the only anesthesia provider in house. The other on-call anesthesia provider was at least 20-minutes away. Eric walks us through what happened next and how they proceeded with the decision to simultaneously rescue the baby and perform an emergency percutaneous cricothyrotomy, followed by surgical cricothyrotomy.
Kristin and Eric talk about the decision making and challenges involved in this case and advice for other anesthesia providers when it comes to emergency airway management. It’s a harrowing story that had lasting impacts on everyone involved in the case. It’s a story of leadership in emergencies, profoundly difficult decision making and an example of why we should train for failed airways in our day-to-day, week-to-week work lives: we have to be ready when disaster strikes.
I recently caught back up with Eric following his retirement from anesthesia. In episode 29 of Anesthesia Guidebook, the podcast that follows this one, Eric reflects back on both this case and the impact that telling this story had on his own life and career. We will also talk about retirement, take a look back over his career and hit on advice he would give to anesthesia providers who are still in the thick of it. Be sure to check the next episode out to hear more from Eric!
Below are links to key resources for difficult airway management.
The Vortex Approach – real-time airway crisis cognitive aids.
Chrimes, N., Bradley, W. P. L., Gatward, J. J., & Weatherall, A. D. (2019). Human factors and the ‘next generation’airway trolley. https://doi.org/10.1111/anae.14543
American Society of Anesthesiologist’s Difficult Airway Guidelines
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4 replies on “#28 Can’t Intubate, Can’t Oxygenate (CICO) during stat C-section: a case study with Eric Carlson, CRNA”
I graduated from anesthesia in 1986 so know exactly what Eric went through. I hated OB and C Sections. He was right in that during that time we had very limited equipment for difficult airways. Many times I was the only anesthesia provider and it can be scary when it is only you. Glad it was a positive outcome for him. I had a case that I Will remember until the day I pass away. It was a child that died on the OR table from a massage embolus during spinal surgery. Nothing we did could bring him back. But I always think in the back of my mind did I miss something. I am now retired after 30 years.
Thanks, Brenda, for your comment! I’m sorry you experienced that case. I hope you’re able to talk with someone about your experience even after all these years. What we do is a massively important thing and the risk of terrible outcomes and even death is there – even to a small degree – with every case. I’m sure you did everything in your power in that case. I wish you the best as you reflect back on that and keep moving forward today & tomorrow.
Thanks for your comment. It is something that I will always remember. I didn’t tell that I had a anesthesia student with me during that case so who knows what kind of impact it had on him. He was a first year student
That certainly adds to your stress and of course the experience would be undoubtedly impactful for the SRNA. I try to have my eye out for SRNAs, new nurses & others with the heaviness of certain cases. At least SRNAs have likely managed death in the ICUs. Many new OR nurses have never seen a patient die in the OR. So when these extremely difficult cases happen, as you know, it’s not a bad idea to check in with staff & learners afterwards.