Emergency cricothyrotomy in five in-hospital “cannot intubate, cannot oxygenate” cases: a case series

Background: Emergency cricothyrotomy (CTM) is a rare but life-saving procedure performed under "cannot intubate, cannot oxygenate" (CICO) conditions. This study describes five in-hospital CICO cases requiring CTM, including one improvised procedure performed in a psychiatric ward without a formal airway kit, to highlight the procedural challenges and institutional preparedness. Methods: This retrospective case series included five consecutive patients treated between April 2021 and April 2024. Data on patient demographics, causes of airway obstruction, procedural techniques, operator experience, and outcomes were also collected. Results: CTM was successful in all patients on the first attempt, and they all survived and were successfully discharged. However, one patient developed hypoxic encephalopathy. Conclusions: CTM remains a rare but essential life-saving intervention for in-hospital CICO cases. Institutional preparedness - including standardized kits, simulation-based training, and regular competency maintenance - is crucial for improving safety and outcomes across hospital departments.