The success and quality of emergency intubation is dependent on both patient and operator factors. In emergency department settings, the success rate of inserting a breathing tube on the first attempt is approximately 78 per cent. Since ideal conditions and high expertise cannot be guaranteed for all emergency intubations despite best efforts, the optimisation of patient and operator related factors are paramount.

The Transnasal Humidified Rapid-Insufflation Ventilatory Exchange (THRIVE) technique has been shown to prolong apnoeic oxygenation time in adult patients. This allows intubation to be performed on patients with expected difficult airways in a timely and relaxed manner. Continued post induction oxygen delivery is then made possible by using high flow nasal prongs during attempted intubation in patients with known difficult anatomical airways and compromised cardiorespiratory function. When using the traditional pre-oxygenation technique however, the oxygen reservoir is no longer renewed after the facemask is removed.

There is a gap in the current clinical literature when it comes to studies investigating the use of THRIVE apnoeic oxygenation in children. Our aim is to use the findings and experience gained from the proof of concept study ‘Transnasal Humidified Rapid-Insufflation Ventilator Exchange (THRIVE) in children: a randomised control trial’ published the British Journal of Anaesthesia in 2016 in healthy children, and extend it to focus on children in emergency settings. By doing this we intend to demonstrate that THRIVE can improve patient and operator dependent conditions and reduce adverse events related to intubation such as desaturation, hypotension and the number of intubation attempts.