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Airway Management Practices and Outcomes Over Time in Neonates and Young Infants Presenting for Cardiac Procedures
Katherine L Zaleski1, Madhankumar Sathyamoorthy2, Tyler Unsicker2
1Department of Anesthesia, Harvard Medical School, Boston, MA; Department of Anesthesiology, Critical Care and Pain Medicine, Boston Children's Hospital, Boston, MA.
Journal of Cardiothoracic and Vascular Anesthesia
|January 4, 2026
Summary
Standard blade video laryngoscopy (SVL) use increased in neonates and infants undergoing cardiac intervention, improving first-attempt tracheal intubation success rates. This shift also led to a reduced incidence of difficult intubations in this vulnerable population.
Area of Science:
- Pediatric Anesthesiology
- Critical Care Medicine
- Neonatalogy
Background:
- Airway management in neonates and infants undergoing cardiac intervention presents unique challenges.
- Tracheal intubation is a critical procedure for ensuring adequate ventilation and oxygenation in these patients.
- Understanding intubation success rates and factors influencing difficulty is crucial for optimizing patient outcomes.
Purpose of the Study:
- To determine the success rate of first-attempt tracheal intubation in neonates and young infants undergoing cardiac intervention.
- To assess the incidence of difficult intubation in this specific patient group.
- To analyze trends in airway management techniques and their association with patient outcomes.
Main Methods:
- Retrospective, observational cohort study conducted at a single academic quaternary children's hospital.
- Analysis of tracheal intubation data for neonates and infants less than 2 months old between August 2012 and May 2024.
- Evaluation of first-attempt success rates, difficult intubation incidence, and the impact of standard blade video laryngoscopy (SVL) versus direct laryngoscopy.
Main Results:
- A total of 2,308 anesthetics were analyzed, with a first-attempt tracheal intubation success rate of 81.2% and a difficult intubation incidence of 3.9%.
- The use of SVL significantly increased from 4.8% (2012-2017) to 71.0% (2018-2024).
- SVL use was associated with a higher first-attempt success rate (87.0%) compared to direct laryngoscopy (78.2%) and a lower incidence of difficult intubation (2.3% vs. 4.8%).
Conclusions:
- The adoption of standard blade video laryngoscopy has increased over time for airway management in neonates and infants undergoing cardiac procedures.
- SVL is associated with improved first-attempt tracheal intubation success rates.
- Utilizing SVL correlates with a decreased incidence of difficult intubations in this pediatric population.
Keywords:
cardiac surgerycongenital heart diseasedifficult airwayneonatal airway managementpediatric anesthesiavideo laryngoscopyMore Related Videos
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