Training for pediatric cannot intubate cannot oxygenate: surgical airway should replace needle cricothyrotomy

Area of Science:

• Pediatric Emergency Medicine
• Airway Management
• Surgical Education

Background:

• Failed pediatric endotracheal intubation necessitates emergency front of neck access (eFONA).
• Needle cricothyrotomy is a standard but challenging technique for pediatric cannot intubate cannot oxygenate (CICO) scenarios.
• Maintaining competency in rare pediatric eFONA procedures is difficult for providers.

Purpose of the Study:

• To examine the utility of continuing to teach needle cricothyrotomy in pediatric eFONA training.
• To explore alternative methods for pediatric emergency airway management.
• To recommend a multidisciplinary approach to pediatric eFONA training.

Main Methods:

• Multidisciplinary review of current pediatric eFONA training practices.
• Analysis of the technical difficulties and rarity of needle cricothyrotomy.
• Exploration of human performance factors in pediatric airway emergencies.

Main Results:

• Needle cricothyrotomy is technically difficult and rarely performed, posing competency challenges.
• Current training methods may not adequately prepare providers for pediatric eFONA.
• Surgical tracheotomy may offer a more viable alternative for pediatric eFONA training.

Conclusions:

• Pediatric eFONA training should prioritize surgical tracheotomy over needle cricothyrotomy.
• Training should incorporate specialty-specific human performance factors.
• A shift in training focus is recommended to improve pediatric emergency airway management outcomes.