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Difficult airway & CICO

Airway & Ventilation

For healthcare professionals. This information does not replace clinical judgement in the individual case; the current summary of product characteristics and the guidelines cited are authoritative.

Medically reviewed: Dr. med. univ. Daniel Pehböck, DESA, 03.11.2026

Difficult airway & CICO: Prediction – before every induction, Physiologically difficult airway – "Resuscitate before you intubate", Preoxygenation and apnoeic oxygenation, Plans A–D in detail (DAS 2025), Neuromuscular blockade in CICO, eFONA: scalpel – bougie – tube (adults, children from approx. 8 y) – concise for emergency, anaesthesia and intensive care teams, with sources and medically reviewed.

What the chapter covers

  1. Prediction – before every induction
  2. Physiologically difficult airway – "Resuscitate before you intubate"
  3. Preoxygenation and apnoeic oxygenation
  4. Plans A–D in detail (DAS 2025)
  5. Neuromuscular blockade in CICO
  6. eFONA: scalpel – bougie – tube (adults, children from approx. 8 y)
  7. Children under approx. 8 years
  8. Vortex – three lifelines
  9. Communication
  10. After the airway

Complete in the app

Weight-based doses in mg and ml, tables, algorithms and calculators – also offline, on phone, tablet and PC. Try full access free for 7 days.

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Drugs in this chapter

Sources and guidelines

  1. Ahmad I et al. Difficult Airway Society 2025 guidelines for management of unanticipated difficult tracheal intubation in adults. Br J Anaesth 2026;136(1):283–307 (Epub 07.11.2025, PubMed 41203471), Algorithmus Plan A–D.
  2. Frerk C, Mitchell VS, McNarry AF et al. Difficult Airway Society 2015 guidelines for management of unanticipated difficult intubation in adults. Br J Anaesth 2015;115:827–848 (Vorgängerfassung; Einzelschritte Skalpell.
  3. Piepho T, Kriege M, Byhahn C, Cavus E, Dörges V, Ilper H et al. S1-Leitlinie Atemwegsmanagement 2023 (DGAI), AWMF-Register 001-028, Version 2023-09, gültig ab 21.08.2023 für 5 Jahre. Anästh Intensivmed 2024;65:69–96.
  4. Timmermann A, Böttiger BW, Byhahn C et al. S1-Leitlinie Prähospitales Atemwegsmanagement (Kurzfassung), DGAI-Beschluss 25.02.2019, AWMF-Register 001-040. Anästh Intensivmed 2019;60:316–336.
  5. Bernhard M, Bein B, Böttiger BW et al. Handlungsempfehlung Prähospitale Notfallnarkose beim Erwachsenen (DGAI, S1), 2015 (Anästh Intensivmed bzw. Notfall Rettungsmed 2015)
  6. Apfelbaum JL, Hagberg CA, Connis RT et al. 2022 American Society of Anesthesiologists Practice Guidelines for Management of the Difficult Airway. Anesthesiology 2022;136:31–81.
  7. Ahmad I, El-Boghdadly K, Bhagrath R et al. Difficult Airway Society guidelines for awake tracheal intubation (ATI) in adults. Anaesthesia 2020;75:509–528.
  8. Higgs A, McGrath BA, Goddard C et al. (DAS, ICS, FICM, RCoA). Guidelines for the management of tracheal intubation in critically ill adults. Br J Anaesth 2018;120:323–352.
  9. Mushambi MC, Kinsella SM, Popat M et al. Obstetric Anaesthetists' Association and Difficult Airway Society guidelines for the management of difficult and failed tracheal intubation in obstetrics. Anaesthesia 2015;70:1286–1306.
  10. The Protected Airway: DAS 2025 Update.
  11. Mosier JM, Joshi R, Hypes C et al. The physiologically difficult airway. West J Emerg Med 2015;16:1109–1117.
  12. Kornas RL, Owyang CG, Sakles JC, Foley LJ, Mosier JM (Society for Airway Management's Special Projects Committee). Evaluation and management of the physiologically difficult airway.
  13. Karamchandani K et al. (SOCCA Physiologically Difficult Airway Task Force). Tracheal intubation in critically ill adults with a physiologically difficult airway. An international Delphi study. Intensive Care Med 2024;50:1563–1579.
  14. Gibbs KW, Semler MW, Driver BE et al. (PREOXI). Noninvasive ventilation for preoxygenation during emergency intubation. N Engl J Med 2024;390:2165–2177.
  15. Weingart SD, Levitan RM. Preoxygenation and prevention of desaturation during emergency airway management. Ann Emerg Med 2012;59:165–175 (apnoische Oxygenierung über Nasenbrille 15 l/min).
  16. Chrimes N, Higgs A, Hagberg CA et al. Preventing unrecognised oesophageal intubation.
  17. Chrimes N. The Vortex.
  18. Brown CA III, Sakles JC, Mick NW et al. (Hrsg.). The Walls Manual of Emergency Airway Management, aktuelle Auflage, Wolters Kluwer.
  19. Association of Paediatric Anaesthetists of Great Britain and Ireland (APA) und Difficult Airway Society. Paediatric difficult airway guidelines (2012; Algorithmen für Kinder von 1–8 Jahren inkl. CICO mit Kanülen-Krikothyreotomie); Black AE, Flynn PER, Smith HL, Thomas ML, Wilkinson KA. Development of a guideline for the management of the unanticipated difficult airway in pediatric practice. Paediatr Anaesth 2015;25:346–362.
  20. All India Difficult Airway Association 2025 guidelines for the management of unanticipated difficult airway in paediatrics under general anaesthesia. Indian J Anaesth 2025 (11/2025)
  21. Übersichtsarbeit zur Notfall-Koniotomie (eFONA) bei Kindern. Front Disaster Emerg Med 2026.
  22. Life in the Fast Lane (LITFL). Airway.
  23. Soar J, Böttiger BW et al. European Resuscitation Council Guidelines 2025 Adult Advanced Life Support. Resuscitation 2025;215 Suppl 1:110769 (Korrigendum 2026).
  24. Djakow J, Turner NM, Skellett S et al. European Resuscitation Council Guidelines 2025 Paediatric Life Support. Resuscitation 2025;215 Suppl 1:110767.
  25. Summaries of product characteristics of authorised products – product and section for each dose in the app.