Peer-reviewed article

A scalable educational intervention to reduce airway-related harm in low-resource PICUs: A design-test-scale experience.

Larrow DR, Zablah E, Callans K, Osorio S, Flores LJG et al. · 24 Sept 2026

Abstract

Problem Across low- and middle-income countries (LMICs), an estimated 1.7 billion children lack access to safe surgical and perioperative care. In Latin America, pediatric postoperative mortality remains several-fold higher than in high-income countries, driven largely by preventable airway and critical-care complications. Following the death of an infant after an unplanned extubation in El Salvador, system-level gaps in airway safety, sedation, and communication were identified, motivating development of a scalable intervention to strengthen postoperative critical care for intubated children. Setting This work was designed at Hospital Nacional de Niños Benjamín Bloom, in San Salvador and subsequently tested at Fundación Hospital Infantil Napoleón Franco Pareja in Cartagena, Colombia. Both institutions faced high unplanned extubation rates, variable airway-safety practices, and limited structured training. Approach Using Ariadne Labs ARC (Design-Test-Scale) implementation pathway, we created a bilingual, online pediatric airway and critical-care curriculum alongside a telesimulation-based emergency team-training program. Forty-five short, multilingual video modules addressed airway management, sedation, respiratory therapy, nursing priorities, and teamwork. Remote, high-fidelity simulation reinforced crisis resource management and role clarity, with local champions trained to run courses independently. Results In El Salvador, early implementation was associated with reductions in unplanned extubations and PICU mortality. In Colombia, 101 clinicians completed the curriculum and 39 completed telesimulation training, with mortality declining from 22.4% to 9.5% post-intervention. Lessons learned A combined digital curriculum and telesimulation model can strengthen airway safety, communication, and crisis readiness in resource-constrained PICUs. Following successful design and testing, the model is positioned for scale across LMIC pediatric intensive care settings.