Background and Goal of Study:
There is currently no evidence regarding the best technique for a paediatric emergency surgical airway. The aim of this study was to give an overview of current literature with regard to the best management of a paediatric "can´t intubate can´t ventilate" scenario in order to give recommendations to establish a best practice procedure.

Materials and Methods:
We conducted a systematic review of emergency surgical airways in children. We included studies that had the following outcomes: time to tracheal access, etCO2 and/or effective ventilation, the success rate, complications and perceived ease of use. Because of the nature of the original studies it was not possible to perform a meta-analysis, we therefore reported data for the different techniques as a S(trenghts)W(eaknesses) O(pportunities) T(hreats)-analysis. Strengths and Weaknesses describe the intrinsic (dis)advantages of the techniques respectively. The opportunities and threats describe the (dis)advantage of the techniques in the setting of a paediatric can´t intubate, can´t ventilate scenario. 

Results and Discussion:
The 5 original studies that met our inclusion criteria described 4 techniques; catheter over needle (CN), wire-guided (W), cannula (C) or scalpel (S) technique. Success rates were 43% (10/23), 100% (4/4), 56% (87/154) and 93% (43/46) respectively. Complication rates were 34% (3/10), 69% (11/16), 36% (55/151) and 38% (18/48) respectively. Mean time for placement was 43s (32-57) for CN, 60s (26-121) for C and 89s (71-128) for S. No time was reported for W. SWOT analysis: CN: quick but high failure rate, W: high success rate but also high complication rate, C: Less complications but high failure rate, S: high success rate but takes longer. However, as this data is heterogeneous and limited, these results need to be interpreted with caution. Regular training will improve success rates of all techniques. In order to be able to establish best practice management we propose a format for further studies with standardised methods, models, techniques and outcome sheets to facilitate pooling.   

Conclusion:
The absence of best practice evidence necessitates further studies in a standardised format to provide a clear advice on best practice management for the paediatric emergency surgical airway in the "can't intubate, can't ventilate" scenario.

The emergency surgical airway in children: what is the plan?