The emergency paediatric surgical airway: A systematic review

Eur J Anaesthesiol. 2018 Aug;35(8):558-565. doi: 10.1097/EJA.0000000000000813.


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.

Publication types

  • Case Reports
  • Systematic Review

MeSH terms

  • Airway Management / methods*
  • Airway Management / standards
  • Animals
  • Controlled Clinical Trials as Topic / methods
  • Emergency Medical Services / methods*
  • Emergency Medical Services / standards
  • Humans
  • Intubation, Intratracheal / methods*
  • Intubation, Intratracheal / standards