PMID- 33526261
OWN - NLM
STAT- MEDLINE
DCOM- 20210331
LR  - 20210331
IS  - 1471-6771 (Electronic)
IS  - 0007-0912 (Linking)
VI  - 126
IP  - 4
DP  - 2021 Apr
TI  - Rabbit training model for establishing an emergency front of neck airway in 
      children.
PG  - 896-902
LID - S0007-0912(20)31054-0 [pii]
LID - 10.1016/j.bja.2020.12.032 [doi]
AB  - BACKGROUND: A 'cannot intubate, cannot oxygenate' (CICO) situation is rare in 
      paediatric anaesthesia, but can always occur in children under certain emergency 
      situations. There is a paucity of literature on specific procedures for securing 
      an emergency invasive airway in children younger than 6 yr. A modified emergency 
      front of neck access (eFONA) technique using a rabbit cadaver model was developed 
      to teach invasive airway protection in a CICO situation in children. METHODS: 
      After watching an instructional video of our eFONA technique (tracheotomy, 
      intubation with Frova catheter over which a tracheal tube is inserted), 29 
      anaesthesiologists performed two separate attempts on rabbit cadavers. The 
      primary outcome was the success rate and the performance time overall and in 
      subgroups of trained and untrained participants. RESULTS: The overall success 
      rate across 58 tracheotomies was 95% and the median performance time was 67 s 
      (95% confidence interval [CI], 56-76). Performance time decreased from the first 
      to the second attempt from 72 s (95% CI, 57-81) to 61 s (95% CI, 50-81). 
      Performance time was 59 s (95% CI, 49-79) for untrained participants and 72 s 
      (95% CI, 62-81) for trained participants. Clinical experience and age of the 
      participants was not correlated with performance time, whereas the length of the 
      tracheotomy incision showed a significant correlation (P=0.006). CONCLUSION: This 
      eFONA training model for children facilitates rapid skill acquisition under 
      realistic anatomical conditions to perform an emergency invasive airway in 
      children younger than 2 yr.
CI  - Copyright (c) 2021 British Journal of Anaesthesia. Published by Elsevier Ltd. All 
      rights reserved.
FAU - Both, Christian P
AU  - Both CP
AD  - Department of Anaesthesiology, University Children's Hospital Zurich, Zurich, 
      Switzerland; Children's Research Centre, University Children's Hospital Zurich, 
      Zurich, Switzerland.
FAU - Diem, Birgit
AU  - Diem B
AD  - Department of Anaesthesiology, University Children's Hospital Zurich, Zurich, 
      Switzerland.
FAU - Alonso, Elena
AU  - Alonso E
AD  - Department of Anaesthesiology, University Children's Hospital Zurich, Zurich, 
      Switzerland; Department of Anaesthesiology, University Hospital Zurich, Zurich, 
      Switzerland.
FAU - Kemper, Michael
AU  - Kemper M
AD  - Department of Anaesthesiology, University Children's Hospital Zurich, Zurich, 
      Switzerland; Department of Anaesthesiology, University Hospital Aachen, Aachen, 
      Germany.
FAU - Weiss, Markus
AU  - Weiss M
AD  - Department of Anaesthesiology, University Children's Hospital Zurich, Zurich, 
      Switzerland; Children's Research Centre, University Children's Hospital Zurich, 
      Zurich, Switzerland.
FAU - Schmidt, Alexander R
AU  - Schmidt AR
AD  - Children's Research Centre, University Children's Hospital Zurich, Zurich, 
      Switzerland; Department of Anaesthesiology, Perioperative and Pain Medicine, 
      Stanford University, School of Medicine, Palo Alto, CA, USA.
FAU - Deisenberg, Markus
AU  - Deisenberg M
AD  - Department of Anaesthesiology, University Children's Hospital Zurich, Zurich, 
      Switzerland.
FAU - Thomas, Jorg
AU  - Thomas J
AD  - Department of Anaesthesiology, University Children's Hospital Zurich, Zurich, 
      Switzerland; Children's Research Centre, University Children's Hospital Zurich, 
      Zurich, Switzerland. Electronic address: joerg.thomas@kispi.uzh.ch.
LA  - eng
PT  - Journal Article
DEP - 20210130
PL  - England
TA  - Br J Anaesth
JT  - British journal of anaesthesia
JID - 0372541
SB  - IM
MH  - Airway Management/methods/*standards
MH  - Anesthesiologists/education/standards
MH  - Animals
MH  - Child
MH  - Child, Preschool
MH  - Clinical Competence/*standards
MH  - Humans
MH  - Infant
MH  - Infant, Newborn
MH  - Intubation, Intratracheal/methods/*standards
MH  - *Manikins
MH  - Rabbits
MH  - Tracheotomy/*education/methods/*standards
OTO - NOTNLM
OT  - bougie
OT  - cannot intubate, cannot oxygenate
OT  - emergency front of neck airway
OT  - emergency tracheotomy
OT  - paediatric airway
OT  - rabbit cadaver model
EDAT- 2021/02/03 06:00
MHDA- 2021/04/01 06:00
CRDT- 2021/02/02 05:48
PHST- 2020/07/14 00:00 [received]
PHST- 2020/12/24 00:00 [revised]
PHST- 2020/12/24 00:00 [accepted]
PHST- 2021/02/03 06:00 [pubmed]
PHST- 2021/04/01 06:00 [medline]
PHST- 2021/02/02 05:48 [entrez]
AID - S0007-0912(20)31054-0 [pii]
AID - 10.1016/j.bja.2020.12.032 [doi]
PST - ppublish
SO  - Br J Anaesth. 2021 Apr;126(4):896-902. doi: 10.1016/j.bja.2020.12.032. Epub 2021 
      Jan 30.