Case Report: A "Cannot Intubate, Cannot Ventilate" Situation Rescue by eFONA in Critical Care Unit

43-years-old male came to ER with recurrent history of squamous cell carcinoma of oral cavity, received two cycles of chemotherapy. Admitted in ward i/v/o cough, fever, mild breathlessness and drop in urine output. Initially taken on 6lpm o2 by mask, vital trend: pulse-140/min, BP-130/80, spo2~93%. On auscultation AEBE, mild crepts in left lower zone. Had desaturation on o2 by mask, taken on NRBM-15lpm o2. On NRBM-15lpm was maintaining saturation less than 80%. Shifted to ICU i/v/o desaturation and increasing respiratory distress and Hypotension, In ICU taken on high flow nasal oxygenation, with higher flow-60lpm, and fio2-1.0. Vital trend: pulse- 130/min, BP-100/60, saturation~87%. Underwent CT scan- suggestive of b/l consolidation. Required higher dose of norad infusion. In spite had severe hypotension and respiratory distress, taken on non-invasive ventilation and NORAD dosage was also increased. Patient went into Brady arrest, immediately CPCR started as per ACLS protocol. Started with bag mask ventilation, but could not achieve ventilation, no chest rise could be seen. Patient desaturated up to60%. Tracheal intubation attempted with video laryngoscope, the view was CL-grade-4 suggesting difficult airway. Laryngeal mask airway (LMA) was placed but ventilation was still not achieved. ?Cannot intubate, cannot ventilate and oxygenate? (CICO) situation was declared. LMA was removed and Emergency front of neck access (eFONA) was performed, and ventilation was achieved. Patient had ROSC for next one hour, again underwent Brady arrest, could not revive after 45minutes of following ACLS protocol and declared dead.