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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.
Insights
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.
Objectives:
The primary aim of this work was to determine the rate of successful first-attempt tracheal intubation and the incidence of difficult intubation in neonates and young infants requiring airway management for cardiac intervention. Secondary aims were to describe evolving airway management practices over time and evaluate the association between the technique for the first tracheal intubation attempt and patient outcomes.
Design:
Retrospective, observational cohort study.
Setting:
Single-center, academic quaternary children's hospital.
Participants:
Neonates and infants less than 2 months old requiring tracheal intubation for cardiac intervention between August 2012 and May 2024.
Interventions:
None.
Measurements And Main Results:
The first-attempt tracheal intubation success rate, incidence of difficult intubation, and trends in the use of standard blade video laryngoscopy (SVL) were measured. In patients undergoing 2,308 anesthetics, the median age and weight were 9.3 days (interquartile range 4.3-37.6) and 3.3 kg (interquartile range 2.8-3.7). The first-attempt tracheal intubation success rate was 81.2% (1,875/2,308, 95% confidence interval 79.6%-82.8%), and difficult intubation occurred in 3.9% (89/2,308, 95% confidence interval 3.2%-4.8%). Use of SVL increased over time (52/1,084, 4.8% [2012-2017] to 866/1,220, 71.0% [2018-2024], p < 0.001). Compared with direct laryngoscopy, SVL was associated with an increased first-attempt success rate (87.0%, 799/918 for SVL v 78.2%, 1,072/1,371 for direct laryngoscopy, p < 0.001) and decreased incidence of difficult intubation (2.3% [21/918] for SVL v 4.8% [67/1,371] for direct laryngoscopy, p = 0.002).
Conclusions:
Use of SVL increased over the study period and was associated with a higher first-attempt success rate and a lower incidence of difficult intubation.
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