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Airway emergencies presenting to the paediatric emergency department requiring advanced management techniques
Leopold Simma1, Domenic Cincotta1,2,3, Stefan Sabato2,4
1Department of Emergency Medicine, The Royal Children's Hospital, Parkville, Victoria, Australia.
Insights
Pediatric airway emergencies requiring operating room intervention are uncommon but necessitate advanced anesthetic techniques like inhalational induction and fiber-optic intubation. Preparation and training are crucial for managing these critical pediatric cases effectively.
Area of Science:
- Pediatric Anesthesiology
- Emergency Medicine
- Airway Management
Background:
- Airway emergencies in the emergency department (ED) are typically managed with standard equipment.
- The specific patient group requiring urgent operating room (OR) intervention for airway emergencies has not been well-described.
Purpose of the Study:
- To describe a case series of pediatric patients with airway emergencies managed in the OR.
- To detail the anesthetic equipment, techniques, and airway findings in these critical cases.
Main Methods:
- Retrospective cohort study at The Royal Children's Hospital, Melbourne.
- Included patients presenting to the ED with airway emergencies requiring OR management between January 2012 and July 2015.
- Recorded patient characteristics, anesthetic details, and airway findings.
Main Results:
- Twenty-two airway emergencies in 21 pediatric patients were identified.
- Inhalational induction (77.3%) was frequently used, with sevoflurane as the common agent.
- Of 12 intubations, 3 used fiber-optic bronchoscopy; 1 direct laryngoscopy was difficult. First-pass success was 83.3%.
Conclusions:
- Advanced airway techniques are rarely, but predictably, needed for pediatric ED airway emergencies.
- Institutions must prepare for these events with appropriate equipment, personnel, and training for OR management.
Background:
Airway emergencies presenting to the emergency department (ED) are usually managed with conventional equipment and techniques. The patient group managed urgently in the operating room (OR) has not been described.
Aims:
This study aims to describe a case series of children presenting to the ED with airway emergencies managed urgently in the OR, particularly the anaesthetic equipment and techniques used and airway findings.
Methods:
A retrospective cohort study undertaken at The Royal Children's Hospital, Melbourne, Australia. All patients presenting to the ED between 1 January 2012 and 30 July 2015 (42 months) with an airway emergency who were subsequently managed in the OR were included. Patient characteristics, anaesthetic equipment and technique and airway findings were recorded.
Results:
Twenty-two airway emergencies in 21 patients were included over the study period, on average one every 2 months. Median age was 18 months and 43% were male. Inhalational induction was used in 77.3%, combined inhalational and intravenous induction in 9.1%, and intravenous induction alone in 13.6%. The most commonly used inhalational induction agent was sevoflurane, and the most commonly used intravenous induction agents were ketamine and propofol. Ten airway emergencies did not require intubation, seven for removal of inhaled foreign body, two with progressive tracheal stenosis requiring emergent dilatation and one examination under anaesthesia to rule out inhaled foreign body. Of the 12 airway emergencies that required immediate intubation, direct laryngoscopy was used in 9 and fibre-optic intubating bronchoscopy in 3. For intubations performed by direct laryngoscopy, one was difficult (Cormack and Lehane grade 3). First pass success was 83.3%. Adverse events occurred in 3/22 (13.6%) cases.
Conclusion:
Advanced airway techniques, including inhalational induction and intubation via fibre-optic intubating bronchoscope, are rarely but predictably required in the management of patients presenting to the ED. Institutions caring for children should prepare in advance where such patients should be managed, by whom, and provide equipment and training for their care.