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The emergency paediatric surgical airway

A systematic review

Koers, Lena; Janjatovic, Darja; Stevens, Markus F.; Preckel, Benedikt

European Journal of Anaesthesiology (EJA): August 2018 - Volume 35 - Issue 8 - p 558–565
doi: 10.1097/EJA.0000000000000813
Paediatric anaesthesia

BACKGROUND Although an emergency surgical airway is recommended in the guidelines for a paediatric cannot intubate, cannot oxygenate (CICO), there is currently no evidence regarding the best technique for this procedure.

OBJECTIVE To review the available literature on the paediatric emergency surgical airway to give recommendations for establishing a best practice for this procedure.

DESIGN Systematic review: Considering the nature of the original studies, a meta-analysis was not possible.

DATA SOURCES MEDLINE, EMBASE, Cochrane Central Register of Controlled Trials, Cumulative Index to Nursing and Allied Health Literature, Web of Science, Google Scholar and LILACS databases.

ELIGIBILITY CRITERIA Studies addressing the paediatric emergency surgical airway and reporting the following outcomes: time to tracheal access, success rate, complications and perceived ease of use of the technique were included. Data were reported using a Strengths, Weaknesses, Opportunities and Threats analysis. Strengths and Weaknesses describe the intrinsic (dis)advantages of the techniques. The opportunities and threats describe the (dis)advantage of the techniques in the setting of a paediatric CICO scenario.

RESULTS Five studies described four techniques: catheter over needle, wire-guided, cannula or scalpel technique. Mean time for placement of a definitive airway was 44 s for catheter over needle, 67.3 s for the cannula and 108.7 s for the scalpel technique. No time was reported for the wire-guided technique. Success rates were 43 (10/23), 100 (16/16), 56 (87/154) and 88% (51/58), respectively. Complication rates were 34 (3/10), 69 (11/16), 36 (55/151) and 38% (18/48), respectively. Analysis shows: catheter over needle, quick but with a high failure rate; wire-guided, high success rate but high complication rate; cannula, less complications but high failure rate; scalpel, high success rate but longer procedural time. The available data are limited and heterogeneous in terms of reported studies; thus, these results need to be interpreted with caution.

CONCLUSION The absence of best practice evidence necessitates further studies to provide a clear advice on best practice management for the paediatric emergency surgical airway in the CICO scenario.

From the Department of Anaesthesia, Academic Medical Centre, Amsterdam, The Netherlands (LK, MFS, BP) and Department of Anaesthesia, University Medical Centre, Ljubljana, Slovenia (DJ)

Correspondence to Dr. Markus F. Stevens, Department of Anaesthesiology, Academic Medical Centre, Meibergdreef 15, Amsterdam 1105 AZ, The Netherlands E-mail:

Published online 27 April 2018

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© 2018 European Society of Anaesthesiology