{
  "abstract": "Why did you do this work? Managing the critically ill baby in the paediatric emergency department (PED) requires a skilled team proficient in emergency intubation. The high-stakes PED environment, where unwell babies can rapidly deteriorate, presents unique challenges that impact intubation procedural success and patient outcomes. 1 These challenges are intensified by paediatric training programs no longer mandating neonatal intubation competency, along with division of neonatal and paediatric rotations at advanced training and consultant levels.2 Additionally, regional commissioning and centralisation of paediatric surgery for certain paediatric age groups limits elective opportunities for anaesthetic/ITU clinicians in district general hospitals (DGHs) to maintain infant airway skills.3 This study explores the impact of these challenges on clinical practice.What did you do? This is a retrospective analysis of all babies less than 12 weeks old who required intubation within a DGH PED in the UK over 12 months.What did you find? Thirteen babies less than 12 weeks old required intubation, median age 4 weeks old (IQR 6 weeks), of which 5/13(54%) had pre-existing co-morbidities (e.g. extreme prematurity). The most common diagnosis was bronchiolitis, followed by undiagnosed congenital cardiac disease and seizures.Median intubation attempts were 3 (IQR 2.5), with median time from ‘decision to intubate’ to ‘successful intubation’ being 72 minutes (IQR 56).The clinicians who successfully intubated varied – anaesthetic/ITU consultant 4/13(31%), anaesthetic/ITU registrar 2/13(15%), paediatric registrar 2/13(15%), PEM consultant 2/13(15%). Anecdotally success was enhanced through use of video laryngoscopy. Neonatal consultants were called to assist for 3/13(23%) – all babies were less than 4 weeks old and were successfully intubated on first attempt by the NICU consultant. No infant came to harm and all transferred to PICU.What does it mean? Our study highlights the need for targeted strategies to improve procedural success when intubating seriously unwell babies in the PED within DGHs. Central to this is strong collaborative working between paediatrics, PEM, anaesthetics/ITU and NICU. We advocate:Effective working groups between the above specialties – undertaking joint risk management, case reviews and audit meetings.Ensure training opportunities for clinicians to continually update infant airway skills.Development of standard operating procedures which acknowledges that the clinician with the most infant intubation experience, irrespective of specialty, leads the procedure.Departments should consider a policy whereby a NICU consultant is called to lead and/or support the intubation of babies of neonatal age (including CGA) and/or weighing <5 kg. This ensures the most qualified professional oversees airway management for this vulnerable group. This should be accounted for in consultant job planning.This approach will improve the future delivery of safe intubation within the PED.References Kanaris C, Murphy PC. Fifteen-minute consultation: intubation of the critically ill child presenting to the emergency department. Archives of Disease in Childhood – Education and Practice 2022;107:330-337.Service and quality standards for provision of neonatal care in the UK (2022).Pye JK. Survey of general paediatric surgery provision in England, Wales and Northern Ireland. Ann R Coll Surg Engl. 2008;90(3):193-197.",
  "authors": [
    {
      "affiliations": [
        "East and North Hertfordshire NHS Trust"
      ],
      "name": "Rachel Kirk"
    },
    {
      "affiliations": [
        "East and North Hertfordshire NHS Trust"
      ],
      "name": "Isaac Wahnon"
    },
    {
      "affiliations": [
        "East and North Hertfordshire NHS Trust"
      ],
      "name": "Prathiba Chandershekar"
    },
    {
      "affiliations": [
        "East and North Hertfordshire NHS Trust"
      ],
      "name": "Gunjan Jain"
    }
  ],
  "title": "8180 Who should lead intubation? Optimising airway management for critically ill babies in the paediatric ED",
  "uid": "fbbc3275-95e7-58e9-9c3b-5e99f42258b0"
}