Pediatric Neck Rescue Access Comparison
Condition: Tracheostomy Complication; Anesthesia
Study type: Interventional

Summary: 
      Two recent studies explored the emergency tracheotomy technique and the
      scalpel-bougie-tracheostomy technique as a neck rescue access for newborns and infants on a
      rabbit cadaver. Both studies lacked a key feature of real surgical access - bleeding during a
      true emergency. The study's objective was to comparatively assess the two techniques in a
      simulated environment with simulated bleeding and decreasing vital signs from the monitor
      like in real emergencies.
    

Detailed description: 
      With ethical committee's approval the investigarors recruited for this cross-over trial
      pediatric anesthesiologists and intensivists. Emergency tracheotomy consists of four steps:
      vertical skin incision, strap muscles separation (2 Backhaus clamps), anterior luxation of
      the trachea with a 3rd clamp, and vertical puncture with tip-scissors of no more than 2
      tracheal rings to insert the tube. The scalpel-bougie-tracheostomy involves separation of
      neck tissues to expose the trachea and tracheal incision both with a scalpel to insert the
      bougie to facilitate tracheal intubation. Participants were randomized to start either with
      emergency tracheotomy or scalpel-bougie-tracheostomy. They watched an instructional video and
      had four practicing attempts, followed by a fifth attempt which was assessed. Afterward, they
      crossed over to the other technique.
    

Intervention name(s): scalpel-bougie tracheostomy; rapid sequence tracheotomy
Intervention type(s): Procedure; Procedure
Intervention description(s): The assistant places themselves with two preparation clamps at the head end of the table and assists with each hand placed lateral to the neck, so that the operating field is freely accessible. After the trachea or cricoid is palpated, a long median longitudinal skin incision of 2-3 cm is made from the cricoid caudally
The assistant uses straight clamps to pull the two edges of the skin incision apart dorso-laterally. In the event of major bleeding this maneuver should allow the blood to drain off dorsally and the view of the anatomical structures should be less impaired.
Layer by layer of the anatomical structures are cut through with the scalpel and tightened with the clamps accordingly.
Using a longitudinal incision, two to three tracheal rings are cut through distally to the cricoid
An 8 FR Frova catheter is inserted through the orifice into trachea.
A tracheal tube (ID 3.0 mm) is inserted over the Frova catheter to secure the airway permanently.; Orientational palpation and vertical midline skin incision followed by separation of the strap muscles
Exposure of the trachea and cricoid followed by anterior luxation of the trachea with a Backhaus towel clamp
Perform a vertical puncture with a tip scissors between the cricoid and 1st tracheal ring followed by a vertical incision of no more than 2 rings in length.
A tracheal tube (inner diameter 3.0 mm, cuffed) is inserted to secure the airway permanently.
Other intervention name(s): SBT; RST
Allocation: Randomized
Intervention model: Crossover Assignment
Masking: None (Open Label)
Primary purpose: Other
Keywords: pediatric airway; tracheotomy; eFONA; CICO