不能气管插管不能氧合状态的紧急处理策略

Strategies for emergency management of the ＂cannot intubate, cannot oxygenate＂ situation

背景不能气管插管不能氧合状态（“cannot intubate，cannot oxygenate”situation，cmo）是指气管插管失败的同时采用无创方法不能维持患者满意的氧合，是麻醉和急诊治疗中的紧急情况之一。在CICO状态时，为了避免缺氧性脑损害甚至死亡的发生，应立即实施紧急经皮气道。目的介绍与CICO状态有关的一些知识。内容重点阐述CICO的发生率和原因、具有CICO状态危险患者的麻醉管理、常用的紧急经皮气道技术、紧急经皮气道技术的并发症、再氧合后患者的处理和紧急经皮气道技术的培训。趋向明确高危因素和制定合理的麻醉处理方案是降低CICO发生率和严重性的合理路径。为了挽救CICO患者的生命，除了所需的合适设备之外，更重要的是要具有经过良好培训的专业人员，其能够在患者发生不可逆性脑损伤或死亡前作出实施紧急经皮气道技术的决定，并且能够迅速成功地实施紧急经皮气道技术。

Background The ＂Cannot intubate, cannot oxygenate＂ situation （CICO） situation describes the clinical situation where attempted tracheal intubation has failed and oxygenation cannot be maintained by non-invasive means. It is one of the most pressing emergencies in anaesthesia and emergency care. To prevent hypoxic brain damage and death in a CICO situation, emergency percutaneous airway access must be performed immediately. Objective Aims of this review are to induce the knowledge related to CICO situation. Content This article mainly reviews incidence and causation of CICO situation, anesthetic management of patients with a risk of CICO situation, emergency percutaneous airway techniques used mostly in clinical practice, complications of emergency percutaneous airway techniques, management of the patients after re-oxygenation and training of emergency percutaneous airway procedures. Trend Identifying the risk factors and planning appropriate anesthetic management is a rational approach to reduce incidence and severity of CICO situation. It is not only appropriate equipment that will save life of a patient with CICO situation, but also having a trained professional who is able to make the decision to perform an emergency percutaneous airway and then performs this procedure promptly and successfully before the patient suffers irreversible brain damage or death.