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Published on: January 17, 2011
Emergency front-of-neck access in pediatric anesthesia: A narrative review
Anna-Katharina Haag1, Alberto Tredese2, Martina Bordini3
1Department of Anaesthesiology and Pain Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland.
Insights
Emergency front-of-neck access (eFONA) is critical for pediatric airway emergencies. This review proposes standardized protocols and training, incorporating innovative tools like AI and ultrasound to improve safety and outcomes in children.
Area of Science:
- Pediatric Anesthesiology
- Emergency Airway Management
- Surgical Procedures
Background:
- Pediatric patients undergoing general anesthesia face rare but life-threatening airway complications like 'Can't Intubate, Can't Oxygenate' (CICO).
- Emergency front-of-neck access (eFONA) is a critical intervention for CICO, but its success is often hampered by a lack of standardized procedures, equipment, and training.
- Failed eFONA in children can lead to catastrophic outcomes, highlighting the urgent need for improved management strategies.
Purpose of the Study:
- To review the latest evidence on emergency front-of-neck access (eFONA) techniques in pediatric patients.
- To propose a general approach and guide for implementing local protocols and training for pediatric eFONA.
- To introduce innovative technologies that can enhance the precision, safety, and training of pediatric eFONA.
Main Methods:
- A comprehensive literature search was conducted on the use of emergency front-of-neck access (eFONA) in infants and children.
- Eighty-six relevant papers were identified, with eight studies focusing on eFONA techniques and animal model simulations included for detailed analysis.
- Data extracted included primary/secondary outcomes, animal models, experimental design, participants, and equipment used.
Main Results:
- Analysis of eight selected studies provided insights into eFONA techniques and simulations in pediatric models.
- The review synthesized information on various aspects of eFONA, including outcomes, specific models, experimental designs, and equipment.
- Identified gaps in standardized procedures and training for pediatric eFONA.
Conclusions:
- A proposed general approach to pediatric eFONA and a guide for protocol implementation and training are presented.
- Innovative tools such as 3D models, ultrasound, and artificial intelligence are recommended to improve pediatric eFONA precision, safety, and training.
- The findings aim to mitigate catastrophic outcomes associated with failed pediatric eFONA by enhancing preparedness and technique.
Background And Objectives:
Children undergoing airway management during general anesthesia may experience airway complications resulting in a rare but life-threatening situation known as "Can't Intubate, Can't Oxygenate". This situation requires immediate recognition, advanced airway management, and ultimately emergency front-of-neck access. The absence of standardized procedures, lack of readily available equipment, inadequate knowledge, and training often lead to failed emergency front-of-neck access, resulting in catastrophic outcomes. In this narrative review, we examined the latest evidence on emergency front-of-neck access in children.
Methods:
A comprehensive literature was performed the use of emergency front-of-neck access (eFONA) in infants and children.
Results:
Eighty-six papers were deemed relevant by abstract. Finally, eight studies regarding the eFONA technique and simulations in animal models were included. For all articles, their primary and secondary outcomes, their specific animal model, the experimental design, the target participants, and the equipment were reported.
Conclusion:
Based on the available evidence, we propose a general approach to the eFONA technique and a guide for implementing local protocols and training. Additionally, we introduce the application of innovative tools such as 3D models, ultrasound, and artificial intelligence, which can improve the precision, safety, and training of this rare but critical procedure.
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