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Emergency Front-Of-Neck Access in the Pediatric Intensive Care Unit: Development of an Institutional Protocol
Kaoru Tsuboi1, Norihiko Tsuboi1, Noriomi Suzuki2
1Department of Critical Care and Anesthesia, National Center for Child Health and Development, Tokyo, Japan.
Paediatric Anaesthesia
|November 6, 2025
Summary
The "Cannot Intubate, Cannot Oxygenate" (CICO) emergency requires rapid response with pediatric front-of-neck access. This review proposes a streamlined protocol including time limits and extracorporeal membrane oxygenation for improved outcomes.
Area of Science:
- Pediatric Critical Care Medicine
- Emergency Airway Management
- Surgical Procedures
Background:
- The "Cannot Intubate, Cannot Oxygenate" (CICO) scenario presents a rare but critical challenge in pediatric airway management.
- Immediate recognition and intervention are vital for patient survival.
Purpose of the Study:
- To review current evidence on pediatric emergency front-of-neck access (eFNA).
- To propose a streamlined eFNA protocol for the intensive care setting.
- To enhance survival and neurological outcomes in pediatric CICO events.
Main Methods:
- Systematic review of the latest evidence regarding pediatric eFNA.
- Development of a protocol incorporating explicit time limits for eFNA attempts.
- Integration of extracorporeal membrane oxygenation (ECMO) into the management strategy.
Main Results:
- No definitive evidence-based consensus exists for pediatric eFNA best practices.
- Proposed protocol includes time constraints and ECMO for critical cases.
- Emphasis on local protocol organization, equipment readiness, and comprehensive training.
Conclusions:
- A structured approach to pediatric eFNA is crucial for managing CICO events.
- The proposed protocol aims to optimize survival and neurological function.
- Regular training and preparedness are essential for clinicians managing pediatric emergencies.
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