What a nightmare scenario! Premie, oral mass, deviated trachea, blood in the airway. I think all you would need is some screaming parents and maybe accurate hostile fire to make it a complete disaster. I agree that pulling the trigger is often the most difficult call, and that folks who are uncomfortable with surgical airways tend to shy away, preferring instead to continue futile intubation attempts rather than cowboy up and cut. It sounds like this kid would have been doomed without your hard work and quick thinking.
I've never been in a situation where I needed to consider a surgical airway in a neonate. If memory serves, the baby's thyroid obscures the landmarks and cricothyroid membrane. Is this true, and does it therefore make a traditional surgical cric more difficult and more prone to bleed? Also, does the infralaryngeal narrowing of the airway in the baby complicate this procedure?
'zilla