PMID- 32995823
OWN - NLM
STAT- PubMed-not-MEDLINE
LR  - 20240214
DP  - 2020 Sep 27
TI  - Airway emergency management in a pediatric hospital before and during the 
      COVID-19 pandemic.
LID - 2020.09.25.20201582 [pii]
LID - 10.1101/2020.09.25.20201582 [doi]
AB  - OBJECTIVE: Children's hospitals frequently care for infants with various 
      life-threatening airway anomalies. Management of these infants can be challenging 
      given unique airway anatomy and potential malformations. Airway emergency 
      management must be immediate and precise, often demanding specialized equipment 
      and/or expertise. We developed a Neonatal-Infant Airway Safety Program to improve 
      medical responses, communication, equipment usage and outcomes for infants 
      requiring emergent airway interventions. PATIENTS AND METHODS: All patients 
      admitted to our quaternary neonatal and infant intensive care unit (NICU) from 
      2008-2019 were included in this study. Our program consisted of a 
      multidisciplinary airway response team, pager system, and emergency equipment 
      cart. Respiratory therapists present at each emergency event recorded specialist 
      response times, equipment utilization, and outcomes. A multidisciplinary oversite 
      committee reviewed each incident. RESULTS: Since 2008, there were 159 airway 
      emergency events in our NICU (~12 per year). Mean specialist response times 
      decreased from 5.9+/-4.9 min (2008-2012, mean+/-SD) to 4.3+/-2.2 min (2016-2019, 
      p=0.12), and the number of incidents with response times >5 min decreased from 
      28.8+/-17.8% (2008-2012) to 9.3+/-11.4% (2016-2019, p=0.04 by linear regression). As 
      our program became more standardized, we noted better equipment availability and 
      subspecialist communication. Few emergency situations (n=9, 6%) required 
      operating room management. There were 3 patient deaths (2%). CONCLUSIONS: Our 
      airway safety program, including readily available specialists and equipment, 
      facilitated effective resolution of airway emergencies in our NICU and 
      multidisciplinary involvement enabled rapid and effective changes in response to 
      COVID-19 regulations. A similar program could be implemented in other centers.
FAU - Thom, Christopher S
AU  - Thom CS
AD  - Division of Neonatology, Children's Hospital of Philadelphia, Philadelphia, PA.
AD  - Division of Neonatology, Perelman School of Medicine at The University of 
      Pennsylvania, Philadelphia, PA.
FAU - Deshmukh, Hitesh
AU  - Deshmukh H
AD  - Perinatal Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, 
      OH.
FAU - Soorikian, Leane
AU  - Soorikian L
AD  - Division of Neonatology, Children's Hospital of Philadelphia, Philadelphia, PA.
FAU - Jacobs, Ian
AU  - Jacobs I
AD  - Division of Otolaryngology, Children's Hospital of Philadelphia, Philadelphia, 
      PA.
FAU - Fiadjoe, John E
AU  - Fiadjoe JE
AD  - Department of Anesthesiology and Critical Care, Children's Hospital of 
      Philadelphia, Perelman School of Medicine, University of Pennsylvania, 
      Philadelphia, PA, USA.
AD  - Department of Anesthesiology and Critical Care Medicine, Perelman School of 
      Medicine at the University of Pennsylvania, Philadelphia, PA.
FAU - Lioy, Janet
AU  - Lioy J
AD  - Division of Neonatology, Children's Hospital of Philadelphia, Philadelphia, PA.
AD  - Division of Neonatology, Perelman School of Medicine at The University of 
      Pennsylvania, Philadelphia, PA.
LA  - eng
GR  - T32 HD043021/HD/NICHD NIH HHS/United States
PT  - Preprint
DEP - 20200927
PL  - United States
TA  - medRxiv
JT  - medRxiv : the preprint server for health sciences
JID - 101767986
UIN - Int J Pediatr Otorhinolaryngol. 2020 Dec;139:110458. PMID: 33130467
PMC - PMC7523164
OTO - NOTNLM
OT  - Pediatrics
OT  - emergencies
OT  - infant
OT  - intubation
OT  - neonatology
COIS- Conflicts of interest The authors have no relevant conflicts of interest to 
      disclose.
EDAT- 2020/10/01 06:00
MHDA- 2020/10/01 06:01
PMCR- 2020/09/29
CRDT- 2020/09/30 06:16
PHST- 2020/10/01 06:00 [pubmed]
PHST- 2020/10/01 06:01 [medline]
PHST- 2020/09/30 06:16 [entrez]
PHST- 2020/09/29 00:00 [pmc-release]
AID - 2020.09.25.20201582 [pii]
AID - 10.1101/2020.09.25.20201582 [doi]
PST - epublish
SO  - medRxiv [Preprint]. 2020 Sep 27:2020.09.25.20201582. doi: 
      10.1101/2020.09.25.20201582.