Background

Cannot intubate-cannot ventilate situations in healthy children are uncommon but are often associated with poor outcome. Several airway management algorithms suggest emergency tracheal access. Little agreement exists on how to perform emergency front of the neck access (eFONA) in children <8 yr. We studied the learning curves of clinicians performing simulated paediatric eFONA.

Methods

After watching an instructional video, 50 physicians, from five medical specialties, performed 10 emergency tracheotomies on rabbit cadavers. We analysed their learning curves relative to performance time and concurring injuries.

Results

With an overall success rate of 94%, performance time decreased from 107 s (standard deviation [sd], 45) to 55 s (sd 17) over 10 attempts. The learning curve was steep between the first and the fourth attempts with an 11% decrease in performance time (95% confidence interval [CI], 9–13%; P<0.001) per attempt and then flattened to a 4% (95% CI, 3–5%; P<0.001) decrease per attempt between the fourth and the tenth attempt. Age, years of clinical experience, and sex showed a significant effect on the learning curve, whereas medical specialty and adult eFONA experience did not. The 58% (95% CI, 44–72%) probability for severe injury during the first attempt decreased to 14% (95% CI, 8–20%) at the second attempt. Men were more likely to cause minor injuries than women (P<0.001).

Conclusions

Irrespective of medical specialty, paediatric clinicians acquired the eFONA technique within four attempts and were on average able to establish an airway in <1 min when performing emergency tracheotomy on a paediatric airway simulator.

Clinical trial registration

NCT03576352.

中文翻译：

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儿童颈部紧急通行：兔子模型中的一种新的学习方法。

背景

在健康儿童中，不能插管-不能通气的情况很少见，但通常与不良结局有关。几种气道管理算法建议紧急气管进入。在8岁以下的儿童中如何进行紧急颈前入路（eFONA）尚无共识。我们研究了进行模拟儿科eFONA的临床医生的学习曲线。

方法

观看教学视频后，来自五个医学专业的50位医生对兔子尸体进行了10次紧急气管切开术。我们分析了他们与学习时间和并发伤害相关的学习曲线。

结果

总体成功率为94％，经过10次尝试，执行时间从107 s（标准偏差[ sd]为45）减少到55 s（sd 17）。第一次和第四次尝试之间的学习曲线很陡，每次尝试的执行时间减少11％（95％置信区间[CI]，9-13％；P <0.001），然后变平为4％（95％） CI，3-5％；P<0.001）在第四次和第十次尝试之间的每次尝试减少。年龄，多年临床经验和性别对学习曲线有显着影响，而医学专业和成人eFONA经验则没有。在第一次尝试中发生严重伤害的概率为58％（95％CI，44–72％）在第二次尝试中降至14％（95％CI，8–20％）。男性比女性更容易造成轻伤（P <0.001）。

结论

不论医学专业如何，儿科临床医生在四次尝试中均获得了eFONA技术，并且在儿科气道模拟器上进行紧急气管切开术时，平均能够在不到1分钟的时间内建立气道。

临床试验注册

NCT03576352。