[High-risk airway management in pediatric prehospital emergency medicine]

Abstract

We report the case of high-risk airway management performed in prehospital conditions in a 3-year-old boy suffering from a severe head and maxillofacial trauma. Tracheal intubation was decided because of a comatose status associated with an acute upper airway obstruction resulting in severe hypoxaemia. One minute after a rapid sequence induction, difficult laryngoscopy was encountered. Two tracheal intubation attempts failed. During maintained laryngoscopy, a pediatric angulated Eschmann-like stylet was blindly blocked into the trachea using a rotational maneuver. A tracheal tube was railroaded over the stylet while a hypoxic bradycardia installed. The young child was tracheostomized upon arrival in the hospital, and recovered without neurological complication. In the present case, neither facemask nor laryngeal mask ventilation would have been efficient because of oral cavity jaw and sub-mental pharyngeal open wounds. Since most paediatric emergency medicine physician are not familiar with infraglottic airway techniques, our observation questions the safety of rapid sequence induction in case of severe maxillofacial trauma and reinforces the value of pediatric Eschmann-like stylet. Minimal airway tools equipment for difficult paediatric airway management is discussed.