Rabbit training model for establishing an emergency front of neck airway in children

Br J Anaesth. 2021 Apr;126(4):896-902. doi: 10.1016/j.bja.2020.12.032. Epub 2021 Jan 30.


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.

Keywords: bougie; cannot intubate, cannot oxygenate; emergency front of neck airway; emergency tracheotomy; paediatric airway; rabbit cadaver model.

MeSH terms

  • Airway Management / methods
  • Airway Management / standards*
  • Anesthesiologists / education
  • Anesthesiologists / standards
  • Animals
  • Child
  • Child, Preschool
  • Clinical Competence / standards*
  • Humans
  • Infant
  • Infant, Newborn
  • Intubation, Intratracheal / methods
  • Intubation, Intratracheal / standards*
  • Manikins*
  • Rabbits
  • Tracheotomy / education*
  • Tracheotomy / methods
  • Tracheotomy / standards*