Airway management in paediatric anaesthesia in Europe-insights from APRICOT (Anaesthesia Practice In Children Observational Trial): a prospective multicentre observational study in 261 hospitals in Europe

Br J Anaesth. 2018 Jul;121(1):66-75. doi: 10.1016/j.bja.2018.04.013. Epub 2018 May 18.


Background: Critical respiratory events are common in children in the peri-anaesthetic period and are caused by airway and ventilation management difficulties. We aimed to analyse current European paediatric airway management practices and identify the incidence and potential consequences of difficult airway management.

Methods: We performed a secondary analysis of airway and ventilation management details of the European multicentre observational trial (Anaesthesia PRactice in Children Observational Trial, APRICOT) of children from birth to 15 yr of age. The primary endpoint was the incidence of difficult airway management. Secondary endpoints were the associations between difficult airway management, known pre-existing respiratory risk factors, and the occurrence of critical respiratory events.

Results: Details for 31 024 anaesthetic procedures were available for analysis. Three or more tracheal intubation attempts were necessary in 120 children (0.9%) and in 40 children (0.4%) for supraglottic airways insertions. The incidence (95% confidence interval) for failed tracheal intubation and failed supraglottic airway insertions was 8/10 000 (0.08%; 0.03-0.13%) and 8.2/10 000 (0.08%; 0.03-0.14%) children, respectively. Difficulties in securing the airway increased the risk for a critical respiratory event for tracheal tube (2.1; 1.3-3.4) and supraglottic airway (4.3; 1.9-9.9) placement. History of pre-existing respiratory risk factors was significantly associated with critical respiratory events independently of the airway device used.

Conclusions: Airway management practices vary widely across Europe. Multiple airway device insertion attempts and pre-existing respiratory risk factors increase the likelihood of critical respiratory events in children and require further stratification during preoperative assessment and planning. This study highlights areas where education, research, and training may improve perioperative care.

Clinical trial registration: NCT01878760.

Keywords: airway; anaesthesia; children; morbidity.

Publication types

  • Multicenter Study
  • Observational Study

MeSH terms

  • Adolescent
  • Airway Management / methods*
  • Anesthesia / methods*
  • Child
  • Child, Preschool
  • Europe
  • Female
  • Humans
  • Incidence
  • Infant
  • Infant, Newborn
  • Intubation, Intratracheal / adverse effects
  • Intubation, Intratracheal / methods
  • Male
  • Pediatrics / methods*
  • Postoperative Complications / epidemiology
  • Prospective Studies
  • Respiration Disorders / epidemiology
  • Respiration Disorders / etiology
  • Respiration, Artificial
  • Risk Factors
  • Trachea / injuries

Associated data