PRACTICE PARAMETER DIFFICULT AIRWAY INFOGRAPHIC: PEDIATRIC PATIENTS Time OUT Airway Management, Backup & Help Plans [A] “consider Ecmoretective Invasive Airway [AIRWAY PLAN SUCCESFUL? g Ww F OXYGENATION/VENTILATION ADEQUATE? ry YES (MARGINAL NO, Fy OER CALL FOR HELP CALL FOR ELF = eo re F © Oxygenation 5 ‘nition 4 Sse E A Cac attempt? A NO, y YES. | ves ay coer Consider Emerging Patient Coreen en nora) Fig. 4. Difficut airway infographic: Pediatric patient example. “Time Out for identification of the airway management plan. A team-based ‘approach with identfcation ofthe folowing is prefered: te primary away manager and backup manager and role assignment, te primary ‘equipment and the backup equipment, andthe persons) available to help. Contact an ECMO teamatolaryngologic surgeon if noninvasive at- way managements likely to fl (e.., congenital high arway obstuction, away tumor ete) *Color scheme. The colors represent the ability to ‘onygeratetventlate: green, easy orygenationventiation; yellow, dificult or marginal oxygenatiowventlation; and re, impossible cxygenation! ventiation. Reassess oxygenation/ventlation after each attempt and move tothe appropriate box based on the results ofthe oxygenation! Ventlation check. Nonemergency pathway (axygenationventiation adequate for an intubation known or antcipated tobe challenging): delver ‘oxygen throughout airway management atemptaiway management wih the technique/device most familar to the primary airway manager, select from the following devices: supragotc airway, vdeolaryngoscopy, flexible bronchoscopy or combination of these devices (e.g, flexble bronchoscopic intubation through the supragotc airway) other techniques (e.g. lighted styles or rig stylets may be used atthe discretion ofthe clinician; optimize and alternate devices as needed; reassess ventlaton after each attempt: it cirect laryngoscopy attempts (eg, one attemp) wit consideration of standard blade vdeolaryngoszony in feu of direc laryngoscopy; int total attempts (insertion ofthe intubatng device untl is remova by the primary aay manager (e.g, thee attempts) and one addtional attempt by the secondary airway manager; ‘after four attempts, consider emerging the patent and reversing anesthetic drugs if feasible. Clinicians may make futher attempts if the risks and benefits othe patent favor continued attempts. °Margnallemergency pathway (poor or no oxygenaton/vetiation fran intubation known Cor anticipated tobe challenging: reat functional. airway reflexes with drugs) and anatomical (mechanical obstruction; attempt to improve \ventlation with facemask, tracheal intubation, and supragltic aay as appropiate; and fall options fai consider emerging the patient or using advancod invasive techniques. ‘Consider a team debrief aftr al cfcutarway encounters: identity processes that worked well and oppor- ‘unites for system improvement ana provide emotional support to members ofthe eam, particularly when there i paint morbidly or mortality Developed in collaboration with the Society fr Pediatric Anesthesia andthe Pediatric Difficult Intubation Collaborative: John E. Fadjoe, M.D., ‘Thomas Engelhardt. M.D. P.D., FRA. Nicola Disma, M.D., Narasimhan Jagannathan, M.D., MB.A. Britta S. von Unger-Stemberg, M.D., Ph.D, DEAA, FANZ.CA,,and Pete G, Kovatsis, M.D, EAP, % ‘Avesnasiloyy 2022 13631-81 PravceGudetes Copyright © 2021, the American Sociely of Anesthe: sts, All Rights Reserved, Unauthorized reproduction ofthis article is prohibited, 20 ewer pus wen ap ono po eziec sors icsReiseReEgreenin ems sare ppeoRNEG