Difficult paediatric airway and emergency front-of-neck access — branching viva

Opening question

This 2-year-old with Pierre Robin sequence and a documented previous difficult intubation needs intubating for respiratory failure. How do you anticipate the difficulty, and what is your preparation and plan before induction? [2] [3]

Branch 1 — the first laryngoscopy fails

You have given one optimised best attempt and cannot see the cords. What do you do next, and why do you avoid repeating the same direct laryngoscopy? [1] [2]

Branch 2 — deterioration to cannot-intubate-cannot-oxygenate

The supraglottic airway does not oxygenate and the child is bradycardic and cyanosing. What is this state, and what is your immediate action? [1] [4]

Branch 3 — the emergency front-of-neck access technique

The decision is made to perform emergency front-of-neck access. Describe the technique, and explain why it is so difficult and rare in children. [4] [1]

Closing — prevention and the next event

The child survives. How do you prevent the next difficult airway from becoming a cannot-oxygenate airway, and what must you document for the future? [2] [3]