Evidence map›Paper›PMID 41646023›Full record

ArticleThe Laryngoscope2026

Role of Pediatric Otolaryngologist in Pediatric Tracheostomy Code Blue Cases: A New Safety Initiative.

Deepa Shivnani, Miles Jonathan Klimara, M S Shruthi, Dnyanesh Balkrishna Amle, Matthew Ern Lin, Ian Kim, R N Ashwath Ram, Eswaran Venkat Raman, Gnanam Aram, Mallikarjun Ravi Kobal and 3 more

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Article in The Laryngoscope, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 1 paper.

0numbers the graph read from it
0cells of the map it votes in
1citing papers in PubMed
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

1 citing paper in PubMed.

  1. Article
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

13 authors.

Deepa ShivnaniDepartment of Otorhinolaryngology and Head & Neck Surgery, University of Iowa, Iowa City, Iowa, USA.ORCID 0000-0003-2772-2065
Miles Jonathan KlimaraDepartment of Otolaryngology - Head & Neck Surgery, University of Iowa, Iowa City, Iowa, USA.
M S ShruthiDepartment of Otorhinolaryngology and Head & Neck Surgery, Mahadevappa Rampure Medical College, Kalaburagi, Karnataka, India.
Dnyanesh Balkrishna AmleDepartment of Biochemistry, All India Institute of Medical Sciences (AIIMS), Nagpur, India.
Matthew Ern LinDepartment of Head and Neck Surgery, David Geffen School of Medicine at University of California, Los Angeles, Los Angeles, California, USA.ORCID 0000-0001-9914-9670
Ian KimDepartment of Pediatrics and Department of Disease Prevention, Stanford University, Palo Alto, California, USA.
R N Ashwath RamDepartment of Pediatric Intensive Care Unit (PICU), Manipal Hospitals, Bangalore, Karnataka, India.
Eswaran Venkat RamanDepartment of Otorhinolaryngology and Head & Neck Surgery, University of Iowa, Iowa City, Iowa, USA.
Gnanam AramDepartment of Pediatric Emergency, Manipal Hospital, Bangalore, India.
Mallikarjun Ravi KobalDepartment of Pediatrics, Mahadevappa Rampure Medical College, Kalaburagi, Karnataka, India.
Olivia E SpeedDepartment of Otorhinolaryngology- Head & Neck Surgery, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA.ORCID 0000-0002-2316-0221
Maie A St JohnDepartment of Head and Neck Surgery, David Geffen School of Medicine at University of California, Los Angeles, Los Angeles, California, USA.
Dinesh ChhetriDepartment of Head & Neck Surgery, UCLA School of Medicine, Los Angeles, California, USA.

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

objectiveA "Code Blue" is a term to activate an alarm for the resuscitation team for a patient who has a cardiopulmonary arrest. The role of a pediatric otolaryngologist in a tracheostomy-related code blue case is not clearly defined. We aim to describe the role of pediatric otolaryngologists in pediatric tracheostomy code blue (PTCB) cases.

methodsThis retrospective study analyzed pediatric code blue cases in a tertiary care hospital from January 2019 to December 2022, before and after the implementation of a standardized PTCB that includes a pediatric otolaryngologist in the resuscitation team. Primary outcome variables included response time and survival-to-discharge of patients.

resultsThe most common reason for code activation was reduced oxygen saturation. The leading cause for the otolaryngology consultation was tube blockage. Tracheostomy tube change was the most common intervention performed. The mean time of otolaryngology arrival was significantly decreased from 14.0 min pre-implementation to 4.0 min post-implementation (p < 0.001). While including all 48 PTCB events, pediatric otolaryngologist involvement was significantly associated with higher survival-to-discharge (94.4% vs. 66.7%, p = 0.028). While comparing post-PTCB protocol implementation versus pre-implementation, mortality declined from 23.8% to 3.7% with increased discharge rates, although this did not reach statistical significance (p = 0.073).

conclusionInclusion of a pediatric otolaryngologist in the resuscitation team reduces time-to-arrival of the pediatric otolaryngologist to the code blue activation site. Reduced time to pediatric otolaryngologist arrival and completion of interventions by pediatric otolaryngologist are associated with reduced mortality in PTCB events. LEVEL OF EVIDENCE: 3:

Indexed as

Cardiopulmonary ResuscitationHeart ArrestOtolaryngologistsPhysician's RoleTracheostomyChildChild, PreschoolFemaleHumansInfantMaleRetrospective Studiesmultidisciplinary resuscitation teampediatric otolaryngologistpediatrics code bluetracheostomy

Identifiers

PMID41646023
PMCPMC13158825

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.