J Cardiothorac Vasc Anesth. 2025 Dec 7:S1053-0770(25)01208-X. doi: 10.1053/j.jvca.2025.12.005. Online ahead of print.
ABSTRACT
OBJECTIVES: The primary aim of this work was to determine the rate of successful first-attempt tracheal intubation and the incidence of difficult intubation in neonates and young infants requiring airway management for cardiac intervention. Secondary aims were to describe evolving airway management practices over time and evaluate the association between the technique for the first tracheal intubation attempt and patient outcomes.
DESIGN: Retrospective, observational cohort study.
SETTING: Single-center, academic quaternary children's hospital.
PARTICIPANTS: Neonates and infants less than 2 months old requiring tracheal intubation for cardiac intervention between August 2012 and May 2024.
INTERVENTIONS: None.
MEASUREMENTS AND MAIN RESULTS: The first-attempt tracheal intubation success rate, incidence of difficult intubation, and trends in the use of standard blade video laryngoscopy (SVL) were measured. In patients undergoing 2,308 anesthetics, the median age and weight were 9.3 days (interquartile range 4.3-37.6) and 3.3 kg (interquartile range 2.8-3.7). The first-attempt tracheal intubation success rate was 81.2% (1,875/2,308, 95% confidence interval 79.6%-82.8%), and difficult intubation occurred in 3.9% (89/2,308, 95% confidence interval 3.2%-4.8%). Use of SVL increased over time (52/1,084, 4.8% [2012-2017] to 866/1,220, 71.0% [2018-2024], p < 0.001). Compared with direct laryngoscopy, SVL was associated with an increased first-attempt success rate (87.0%, 799/918 for SVL v 78.2%, 1,072/1,371 for direct laryngoscopy, p < 0.001) and decreased incidence of difficult intubation (2.3% [21/918] for SVL v 4.8% [67/1,371] for direct laryngoscopy, p = 0.002).
CONCLUSIONS: Use of SVL increased over the study period and was associated with a higher first-attempt success rate and a lower incidence of difficult intubation.
PMID:41486016 | DOI:10.1053/j.jvca.2025.12.005