Clinical Pathway for Children with Difficult/Critical Airway

  • Patient Requiring Urgent/Emergent Intubation on Inpatient Units
  • (Outside ED, PICU, NICU, CICU, OR)
  • Call 4-CODE
  • Code Team will activate Airway Response Team as necessary

Assess Airway

Review Patient Information in Epic

L.E.M.O.N. Method, 3-3-2 Rule, Mallampatti

Critical Airway Known
Difficult Airway
No Airway Issues Identified
  • While Awaiting Airway Response Team
  • Monitor, Continue O2
  • Consider the following based on airway characteristics:
    • Bag Mask Ventilation
    • Nasal/Oral Airways
    • Laryngeal Mask (LMA)
Perform Bag Mask Ventilation
Use Nasal/Oral Airways as Necessary
Routine Airway Management
by Clinical Team
Failed BVM or Laryngoscopy
  • Consider Laryngoscopy
    • Most Experienced Practitioner
  • Laryngoscopy
    • Most Experienced Practitioner
    • Limit to 2 Attempts
  • To Activate the Airway Response Team:
    • Code Blue
      • Medical Emergency Line, 4-CODE (4-2633)
    • ASCOM Phone
      • Double press button on top of phone
      • Indicate STAT Airway Emergency
      • Give patient location
Airway Response Team Arrives
  • Airway Team Provides Expert Support to Local Team
    • Laryngeal Mask
    • Indirect Laryngoscopy
      • Considerations for Sedation, Neuromuscular Blockade
    • Fiberoptic Laryngoscopy
    • Fiberoptic Laryngoscopy through LMA
    • Invasive Airway

Posted: January 2014
Updated: April 2017, June 2019 (Reviewed)
Authors: A. Nishisaki, MD; R. Giordano, RRT-NPS; J. Lavelle, MD; A. Ades, MD; J. Fiadjoe, MD; J. Lioy, MD; L. Javia, MD; K.Y. Tay, MD; A. Costarino, MD