IntroductionEmergency intubation of children with abnormal respiratory or cardiac physiology is a high-risk procedure and associated with a high incidence of adverse events including hypoxemia. Successful emergency intubation is dependent on inter-related patient and operator factors. Preoxygenation has been used to maximise oxygen reserves in the patient and to prolong the safe apnoeic time during the intubation phase. Transnasal Humidified Rapid Insufflation Ventilatory Exchange (THRIVE) prolongs the safe apnoeic window for a safe intubation during elective intubation. We designed a clinical trial to test the hypothesis that THRIVE reduces the frequency of adverse and hypoxemic events during emergency intubation in children and to test the hypothesis that this treatment is cost-effective compared with standard care.Methods and analysisThe Kids THRIVE trial is a multicentre randomised controlled trial performed in participating emergency departments and paediatric intensive care units. 960 infants and children aged 0–16 years requiring emergency intubation for all reasons will be enrolled and allocated to THRIVE or control in a 1:1 allocation with stratification by site, age (<1, 1–7 and >7 years) and operator (junior and senior). Children allocated to THRIVE will receive weight appropriate transnasal flow rates with 100% oxygen, whereas children in the control arm will not receive any transnasal oxygen insufflation. The primary outcomes are defined as follows: (1) hypoxemic event during the intubation phase defined as SpO2<90% (patient-dependent variable) and (2) first intubation attempt success without hypoxemia (operator-dependent variable). Analyses will be conducted on an intention-to-treat basis.Ethics and disseminationEthics approval for the protocol and consent process has been obtained (HREC/16/QRCH/81). The trial has been actively recruiting since May 2017. The study findings will be submitted for publication in a peer-reviewed journal.Trial registration numberACTRN12617000147381.

With the advancement in technology and increasing familiarity, the use of extracorporeal membrane oxygenation (ECMO) has expanded in the past decade. Although ECMO can be lifesaving for critically ill children, it is an invasive therapy associated with complications that may necessitate rehabilitation and long‐term follow‐up. Paediatric clinicians play an essential role in managing these children, especially after the acute phase of their illness. This review provides an overview of ECMO and will provide a basic understanding of ECMO and its principles.

Objective: To assess the impact of an "evening" Paediatric Intensive Care Unit (PICU) pharmacist role. Method: A pilot program reviewed interventions recorded by an extended hours (until 7 pm) pharmacist in the PICU for the period 18 April until 16 June 2017. Clinical interventions documented via the in-house pharmacy intervention records were reviewed and risk assessed by an independent multidisciplinary panel consisting of a nurse, physician, and a pharmacist. In addition, medication incidents recorded in the broader hospital clinical incident database were reviewed for the study period and also compared to an identical time period in 2016. Results: Of 632 interventions recorded, 144 (23%) interventions were attributed to the evening pharmacist with 108 (90%) of the interventions occurring after 4:30 pm. The intervention categories consisted of 132 (92%) involving prescribing/transcribing and 12 (8%) classified under the administration and monitoring category. No pharmacist intervention was rated as major or extreme severity by any reviewer although the physician was more likely than the pharmacist or nurse to stratify interventions as minor or moderate as opposed to no risk. There was no difference in the hospital clinical incident database between the minimal harm risk medication rated incidents in 2016 compared to the same time period in 2017. Conclusion:The evening clinical pharmacist identified that 9 of 10 patients seen after 4.30 pm required an intervention, clarification, or a change in medication therapy. Future directions to improve medication safety for critically ill children should include staffing of a PICU pharmacist for extended hours on both weekdays and weekends.

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