PMID- 31812268
OWN - NLM
STAT- MEDLINE
DCOM- 20200713
LR  - 20200713
IS  - 1471-6771 (Electronic)
IS  - 0007-0912 (Linking)
VI  - 125
IP  - 1
DP  - 2020 Jul
TI  - Emergency front of neck access in children: a new learning approach in a rabbit 
      model.
PG  - e61-e68
LID - S0007-0912(19)30849-9 [pii]
LID - 10.1016/j.bja.2019.11.002 [doi]
AB  - BACKGROUND: Cannot intubate-cannot ventilate situations in healthy children are 
      uncommon but are often associated with poor outcome. Several airway management 
      algorithms suggest emergency tracheal access. Little agreement exists on how to 
      perform emergency front of the neck access (eFONA) in children <8 yr. We studied 
      the learning curves of clinicians performing simulated paediatric eFONA. METHODS: 
      After watching an instructional video, 50 physicians, from five medical 
      specialties, performed 10 emergency tracheotomies on rabbit cadavers. We analysed 
      their learning curves relative to performance time and concurring injuries. 
      RESULTS: With an overall success rate of 94%, performance time decreased from 107 
      s (standard deviation [sd], 45) to 55 s (sd 17) over 10 attempts. The learning 
      curve was steep between the first and the fourth attempts with an 11% decrease in 
      performance time (95% confidence interval [CI], 9-13%; P<0.001) per attempt and 
      then flattened to a 4% (95% CI, 3-5%; P<0.001) decrease per attempt between the 
      fourth and the tenth attempt. Age, years of clinical experience, and sex showed a 
      significant effect on the learning curve, whereas medical specialty and adult 
      eFONA experience did not. The 58% (95% CI, 44-72%) probability for severe injury 
      during the first attempt decreased to 14% (95% CI, 8-20%) at the second attempt. 
      Men were more likely to cause minor injuries than women (P<0.001). CONCLUSIONS: 
      Irrespective of medical specialty, paediatric clinicians acquired the eFONA 
      technique within four attempts and were on average able to establish an airway in 
      <1 min when performing emergency tracheotomy on a paediatric airway simulator. 
      CLINICAL TRIAL REGISTRATION: NCT03576352.
CI  - Copyright (c) 2019 British Journal of Anaesthesia. Published by Elsevier Ltd. All 
      rights reserved.
FAU - Ulmer, Francis
AU  - Ulmer F
AD  - Department of Paediatrics, Section of Paediatric Critical Care, Bern University 
      Hospital, University of Bern, Bern, Switzerland.
FAU - Lennertz, Julian
AU  - Lennertz J
AD  - Department of Anaesthesiology and Pain Therapy, Inselspital, Bern University 
      Hospital, University of Bern, Bern, Switzerland.
FAU - Greif, Robert
AU  - Greif R
AD  - Department of Anaesthesiology and Pain Therapy, Inselspital, Bern University 
      Hospital, University of Bern, Bern, Switzerland.
FAU - Butikofer, Lukas
AU  - Butikofer L
AD  - CTU Bern, University of Bern, Bern, Switzerland.
FAU - Theiler, Lorenz
AU  - Theiler L
AD  - Department of Anaesthesiology and Pain Therapy, Inselspital, Bern University 
      Hospital, University of Bern, Bern, Switzerland.
FAU - Riva, Thomas
AU  - Riva T
AD  - Department of Anaesthesiology and Pain Therapy, Inselspital, Bern University 
      Hospital, University of Bern, Bern, Switzerland. Electronic address: 
      thomas.riva@insel.ch.
LA  - eng
SI  - ClinicalTrials.gov/NCT03576352
PT  - Journal Article
DEP - 20191204
PL  - England
TA  - Br J Anaesth
JT  - British journal of anaesthesia
JID - 0372541
SB  - IM
MH  - Adult
MH  - Airway Management
MH  - Animals
MH  - Clinical Competence/*statistics & numerical data
MH  - Emergencies
MH  - Female
MH  - Humans
MH  - Male
MH  - Models, Animal
MH  - Rabbits
MH  - Sex Factors
MH  - Tracheotomy/*education
OTO - NOTNLM
OT  - airway management
OT  - difficult airway
OT  - emergency front of neck access
OT  - paediatric airway
OT  - training
EDAT- 2019/12/10 06:00
MHDA- 2020/07/14 06:00
CRDT- 2019/12/09 06:00
PHST- 2019/04/23 00:00 [received]
PHST- 2019/09/09 00:00 [revised]
PHST- 2019/09/19 00:00 [accepted]
PHST- 2019/12/10 06:00 [pubmed]
PHST- 2020/07/14 06:00 [medline]
PHST- 2019/12/09 06:00 [entrez]
AID - S0007-0912(19)30849-9 [pii]
AID - 10.1016/j.bja.2019.11.002 [doi]
PST - ppublish
SO  - Br J Anaesth. 2020 Jul;125(1):e61-e68. doi: 10.1016/j.bja.2019.11.002. Epub 2019 
      Dec 4.