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Published on: January 17, 2011
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.
Insights
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.
Abstract:
"Cannot Intubate, Cannot Oxygenate" is a rare but life-threatening situation that requires immediate recognition, advanced airway management, and ultimately emergency front-of-neck access. All airway practitioners caring for children should be prepared to face these situations. The aim of this review was to provide a concise summary of the latest evidence and to propose a streamlined protocol for pediatric emergency front-of-neck access in the intensive care setting. The strength of our protocol is that we have set explicit time limits for front-of-neck access attempts and incorporated extracorporeal membrane oxygenation to achieve the best possible survival and neurological outcomes. No evidence-based consensus exists on the best practice, although organization of local protocols and equipment, as well as regular and comprehensive training, is crucial to bolster clinician confidence and improve patient outcomes.
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