CHOP Emergency Airway Program Facilitates Rapid Intervention Before and During Pandemic

A new study published in the International Journal of Pediatric Otorhinolaryngology shows that our Emergency Airway Program facilitates rapid airway intervention in our N/IICU and was successful both before and during the COVID-19 pandemic.

Managing infants with life-threatening airway anomalies can be challenging due to their unique anatomy. Unexpected airway emergencies occur frequently in the neonatal intensive care unit and must be addressed immediately and with meticulous care, often with specialized equipment and multidisciplinary expertise.

To address this need, in 2008 CHOP developed a Neonatal and Infant Emergency Airway Program to improve medical responses, communication, equipment usage, and outcomes for all infants requiring emergency airway interventions in the N/IICU. By 2016, the program had been well established, and its standardized measures and streamlined procedures were in regular use, including a multidisciplinary airway response team of pediatric ENT, neonatology, respiratory therapy, and anesthesia-critical care physicians, as well as a specialized pager notification system and an emergency equipment cart.

In order to assess the program’s effectiveness, we analyzed all airway emergency events that occurred in our N/IICU from 2008 to 2019. Respiratory therapists present at each emergency event recorded specialist response times, as well as equipment use and patient outcomes.

Of the 159 airway emergency events included in the study, the mean specialist response time from 2008 to 2019 decreased by more than 1 minute, and the number of incidents with response times greater than 5 minutes decreased by approximately a third. Equipment availability and subspecialist communication also improved. For example, the emergency equipment cart did not initially include a 2.2 mm flexible fiberoptic laryngoscope, but after program implementation, the emergency airway team recognized it was the main bronchoscope used in both diagnosis and airway access. Once we recognized this, a 2.2 mm flexible fiberoptic laryngoscope was written into the budget process and made available during all emergency events.

In response to COVID-19, our Emergency Airway Program team also outfitted a separate cart with extra N95 masks, eye protection, gloves, hand sanitizer, and gowns for all responding personnel. Rapid COVID-19 tests were performed on patients, and appropriate personal protective equipment (PPE) was worn by all members of the team. The effectiveness of this program, both during the pandemic and before, could serve as a model for other similar centers.

Reference

Thom CS, Deshmukh H, Soorikian L, Jacobs I, Fiadjoe J, Lioy J. Airway emergency management in a pediatric hospital before and during the COVID-19 pandemic. Int J Pediatr Otorhinolaryngol. 2020;139:110458.