Advanced Pediatric Emergency Airway Management: A Multimodality Curriculum Addressing a Rare but Critical Procedure

Abstract

Introduction: Advanced airway management in pediatrics is a rare, high stakes skillset. Developing proficiency in these skills is paramount, albeit challenging. Providers require innovative approaches to address initial training and maintenance of procedural competency. To address this, we developed a multimodality curriculum. Methods: Through an interactive problem-based learning session utilizing real intubation videos, hands-on skill stations, and two simulation-based scenarios, participants advanced through educational objectives towards the goal of improving perceived comfort, knowledge, skills, and attitudes in emergency pediatric advanced airway management. Content was developed by integrating varied learning modalities under the learn, see, practice, prove, do, maintain construct. Please note the specialized equipment needed for this curriculum included pediatric airway trainers and a video laryngoscope. Results: We have conducted the curriculum in its entirety four times, reaching 131 interdisciplinary participants. Forty-nine physicians of varying training backgrounds and clinical working environments completed postparticipation evaluations. On a Likert scale ranging from 1 (strongly disagree) to 5 (strongly agree), a significant improvement in perception of comfort with managing the emergent pediatric airway was noted (2.7 to 4.6, p < .0001). Further, 94% of participants reported they strongly agreed (71%) or agreed (23%) that each station added to their perceived knowledge, skills, and attitudes of pediatric airway management. Discussion: After participating in our curriculum, participants self-reported improved comfort in managing the emergent pediatric airway. This curriculum provides educators with resources to navigate the paradigm of obtaining and maintaining competency of a rare but critical skillset.

Quality Improvement of Pediatric Airway Emergency Carts: Standardization, Streamlining, and Simulation

“…According to our survey, participants in the simulation exercise experienced an increase in knowledge, comfort, and confidence in dealing with pediatric emergency airway scenarios. This is consistent with previous demonstrations of the efficacy of simulation training across disciplines, in areas including emergency medicine [19,20], otolaryngology [21], and anesthesia [12,22]. Our finding that the response to an airway emergency is improved by familiarity with the equipment itself is also consistent with other studies showing that providers are most confident with individual pieces of equipment that are used in practice more frequently [23,24], and when they have recently used an emergency equipment cart [25].…”

Usability Testing Via Simulation

“…For each simulation, participants were randomly assigned to 1 of 4 clinical roles: team leader, laryngoscopist, laryngoscopist assistant, and nurse. The order of the cases was standardized, with the “easy airway” case first (a toddler with postictal respiratory failure), followed by a random assignment of 1 of 2 “difficult airway” cases (an infant with Down syndrome and a history of prior difficult airway who presented after witnessed cardiac arrest at home with return of spontaneous circulation after emergency medical services resuscitation or a teenage trauma patient with altered mental status, hemodynamic instability, and cervical spine stabilization concerns) (Appendix 1, Cases 1 and 2A were adapted from a previously established pediatric advanced airway curriculum 20 . Case 2B was a novel case developed for this study).…”

“…The order of the cases was standardized, with the "easy airway" case first (a toddler with postictal respiratory failure), followed by a random assignment of 1 of 2 "difficult airway" cases (an infant with Down syndrome and a history of prior difficult airway who presented after witnessed cardiac arrest at home with return of spontaneous circulation after emergency medical services resuscitation or a teenage trauma patient with altered mental status, hemodynamic instability, and cervical spine stabilization concerns) (Appendix 1, Cases 1 and 2A were adapted from a previously established pediatric advanced airway curriculum. 20 Case 2B was a novel case developed for this study). The "difficult airway" cases were designed to test different items on the checklist (eg, anatomic difficulties related to Down syndrome or cervical spine immobilization and physiologic difficulties related to recent cardiac arrest or hemodynamic compromise with hemorrhagic shock).…”

Management of the Difficult Airway

“…In pediatrics, emphasis on this skill set over repeated attempts at orotracheal intubation has been associated with improved mortality for both in-hospital and out-of-hospital pediatric cardiac arrests 40,41 . This observation speaks to the effectiveness of this lifesaving skill, the perilousness of orotracheal intubations, and importance of mastering BMV, even by novice learners 42–47 …”

“…40,41 This observation speaks to the effectiveness of this lifesaving skill, the perilousness of orotracheal intubations, and importance of mastering BMV, even by novice learners. [42][43][44][45][46][47] There are several key considerations to ensure effective BMV, especially in the management of a difficult pediatric airway. First, any provider responsible for advanced airway management must have a firm understanding of the type of equipment stocked in their setting (ie, self-inflating VS flow inflating anesthesia bags such as Mapleson or Jackson-Rees circuits) and how and when to close the bag's pop-off valve.…”