# Training for pediatric cannot intubate cannot oxygenate: surgical airway should replace needle cricothyrotomy

## TL;DR

The paper argues that surgical tracheotomy should replace needle cricothyrotomy in pediatric emergency airway training due to its higher practicality and effectiveness.

## Contribution

The paper proposes a shift in pediatric emergency airway training from needle cricothyrotomy to surgical tracheotomy based on multidisciplinary analysis.

## Key findings

- Needle cricothyrotomy is technically difficult and rarely used in pediatric CICO scenarios.
- Surgical tracheotomy is suggested as a more viable alternative for pediatric emergency airway management.
- Training should consider specialty-specific human performance factors for better outcomes.

## Abstract

Failed pediatric endotracheal intubation, prompting surgical airway management via emergency front of neck access (eFONA), is an intrinsically challenging topic. While rare, all emergency airway providers must be equipped to handle these complex clinical scenarios, both through initial training and maintenance of competency. Needle cricothyrotomy is a commonly taught method in cannot intubate cannot oxygenate (CICO) scenarios for children under age eight. However, needle cricothyrotomy is technically difficult, profoundly rare, and maintaining competency is a challenge. From a multidisciplinary perspective, we examine the utility of continuing to teach needle cricothyrotomy and explore alternatives. This project group suggests that pediatric eFONA training across disciplines should focus on surgical tracheotomy rather than needle cricothyrotomy, with consideration given to specialty-specific human performance factors.