Riva, T.; Fuchs, A.; Greif, R.; Disma, N.; Riedel, T.; Ulmer, F. (June 2023). Pediatric neck rescue: randomized comparison of two emergency approaches to the trachea in an advanced simulated rabbit model. European journal of anaesthesiology, 40, p. 176. Lippincott Williams & Wilkins
Background and Goal of Study: The rapid-sequence-tracheotomy (RST) and the scalpel-bougie-tracheotomy (SBT) are two recently introduced approaches that have explored establishing emergency front of neck access (eFONA) in an unanticipated difficult paediatric airway situation using a rabbit cadaver as a simulator. The objective of this study was to assess the two techniques in a simulated environment with enhanced realism including operative haemorrhage.
Materials and Methods: 30 doctors were allocated to two groups for this randomized controlled cross-over equivalence trial. Af ter watching an illustrated training video and practicing one of the eFONA techniques four times, participants performed one final tracheotomy which was video recorded and rated. This sequence was then repeated for the other eFONA technique. Randomization determined whether the RST or SBT-technique was done first. Primary outcome was the comparison of the performance times between two surgical rescue techniques. Secondary outcomes included success rate, structural injuries, and subjective participant self-evaluation of their performance.
Rabbit cadavers were acquired commercially and had been slaughtered exclusively for food purposes in accordance with the Swiss law in the presence of the cantonal veterinarian of the canton of Aargau.
Based on previous data, we chose an equivalence margin of Δ= ±10 seconds with respect to the duration of the procedure.
Results and Discussion: The two techniques were not equivalent with respect to the predefined margin of +/- 10 seconds. The median-time difference of 11.0 (95% CI: -4.9 – 29.0) seconds serves as weak evidence suggesting shorter performance time for the the SBT, yet there was no significant difference between the performance times of the two techniques (p = 0.07). The overall success
rate was 93.3% (CI: 83.8% – 98.2%). Participants expressed a significant highly preference for the SBT-technique (p < 0.001). The median performance time difference exceeded our equivalence margin of 10 seconds and therefore we did not find equivalency between the two techniques. Nonetheless there was no significant difference between the performance times of the two techniques.
Conclusion(s): Previously inexperienced clinicians can acquire the skillset needed to perform eFONA in small children in about a minute, by watching training videos. Fewer tracheal injuries and participants’ indicated preferences may favour the SBT.
Item Type: |
Conference or Workshop Item (Abstract) |
|---|---|
Division/Institute: |
04 Faculty of Medicine > Department of Gynaecology, Paediatrics and Endocrinology (DFKE) > Clinic of Paediatric Medicine 04 Faculty of Medicine > Department of Intensive Care, Emergency Medicine and Anaesthesiology (DINA) > Clinic and Policlinic for Anaesthesiology and Pain Therapy 04 Faculty of Medicine > Department of Gynaecology, Paediatrics and Endocrinology (DFKE) > Clinic of Paediatric Medicine > Paediatric Intensive Care |
UniBE Contributor: |
Riva, Thomas, Fuchs, Alexander Fabian, Greif, Robert, Riedel, Thomas, Ulmer, Francis |
Subjects: |
600 Technology > 610 Medicine & health |
ISSN: |
0265-0215 |
Publisher: |
Lippincott Williams & Wilkins |
Language: |
English |
Submitter: |
Alexander Fuchs |
Date Deposited: |
29 Jun 2023 14:32 |
Last Modified: |
29 Jun 2023 14:32 |
Additional Information: |
e-Supplement 60 |
URI: |
https://boris.unibe.ch/id/eprint/184238 |
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