Management of pediatric ‘cannot intubate, cannot oxygenate’

Case “Cannot intubate, cannot oxygenate” ( CICO ) is a rare, life‐threatening situation. We describe a pediatric case of CICO and highlight some educational points.A 3‐year‐old boy who collapsed in the bathtub came to our emergency department. On admission, he went into cardiac arrest probably because of an airway obstruction. We judged his condition as CICO and carried out an emergent tracheostomy after several attempts to perform a cricothyroidotomy failed. We continued resuscitation; however, circulation did not return spontaneously. Outcome The child died, and the autopsy showed an airway obstruction caused by idiopathic anaphylaxis or acquired angioedema. Conclusion This case highlights that it can be anatomically difficult to perform a percutaneous cannula cricothyroidotomy and scalpel cricothyroidotomy safely in pediatric CICO cases. An emergent tracheostomy using the scalpel–finger–bougie technique on the proximal trachea should be considered in such cases.