A study looking into advanced airway management for critically unwell children has resulted in the Paediatric SCRAM™ (Structured CRitical Airway Management) Bag being adopted at a Glasgow hospital

The quality improvement project aimed to reduce “adverse events” related to airway management in emergency situations at the Royal Hospital for Children (RHC) in Glasgow, specifically outside of its paediatric intensive care unit (PICU) and theatre environments.

Led by Dr Jamie Pope of the hospital’s Emergency Department, the project aimed to enhance consistency while improving safety in airway management through a focus on high-quality basic airway management.

Recent evidence had shown that for critically unwell children, “adverse events associated with tracheal intubation can have significant effects on mortality and morbidity.” It was further suggested that critically unwell children are significantly more likely to suffer an adverse event due to intubation, and “there is a high frequency of difficult airways in these patients even when expert teams and clinicians are involved.”

The project’s key concern was that variation in equipment storage and availability of advanced airway equipment to potential non-expert practitioners increased risk to children in emergencies. Therefore, in consultation with the relevant hospital departments, moving to a SCRAM™ Bag of portable airway equipment rather than having different variations of airway equipment based in various emergency trolleys, was assessed.

Findings from the study have now been published in ADC Education & Practice from the British Medical Journal (BMJ) and the Royal College of Paediatrics and Child Health (RCPCH).

From January 2019 to October 2020, all emergency calls to the wards at the Royal Hospital for Children were reviewed with 43 relevant cases identified and four in particular where advanced airway management was performed.

The report states: “With the support of the data, it was decided that the use of SCRAM™ bags would be implemented with a transition and consultation period over the following months within the appropriate departments.

“After a successful consultation and trial period in the emergency department and Paediatric ICU, the SCRAM™ bag system was implemented throughout the hospital.

“From June to September 2021, there was one case of difficult airway management. Encouragingly, there were two cases of excellent practice regarding both basic and advanced airway management and a further case of a patient requiring advanced airway management in the ward setting with no equipment issues recorded.”

Additional benefits of cost reduction for the hospital and reduced waste of unused equipment, lowering the hospital’s environmental impact, were also noted.

Co-creator of Paediatric SCRAM™ Paul Swinton said: “To know that the Royal Hospital for Children has adopted Paediatric SCRAM™ after a period of rigorous testing and concluded that it has seen an improvement in processes, while encouraging best practice and waste reduction, is a highly positive outcome.”

He further emphasised that “Paediatric SCRAM™ was developed to enhance the performance of emergency paediatric airway management for the benefit of both patients and staff working in these demanding medical situations. Seeing the positive results is fantastic and is testament to significant partnership working that informed the development of SCRAM™.”

Further training of non-specialist clinicians in basic airway management is now considered “essential” by the RHC including simulations while extending learnings to other geographical areas.

Paediatric SCRAM™ - developed alongside InnoScot Health then manufactured by Openhouse Products Ltd - is a compact, structured, reproducible approach to paediatric airway management that is able to integrate into any paediatric airway management strategy.

Designed to enhance the performance of emergency paediatric airway management by reducing the time to intervention, reducing error and cognitive load, Paediatric SCRAM™ provides a system for safe and reproducible emergency airway management to be embedded into clinical practice.

It was created initially by Paul Swinton, National Education Lead Scottish Air Ambulance Service, Neil Sinclair – Assistant Clinical Director (Paramedicine) of the Northern Ireland Ambulance Service, and Dr Jon McCormack, Consultant in Paediatric Anaesthesia and Intensive Care Retrieval at the Royal Hospital for Sick Children in Edinburgh. The report on the use of Paediatric SCRAM™ in the Royal Hospital for Children is available online.