Utilizing a Critical Airway Response Team Expedites Esophageal Button Battery Removal


      • Esophageal button battery ingestion can result in significant patient morbidity and mortality; therefore, prompt recognition and treatment is critically important.
      • In this study, implementation of a clinical care algorithm decreased the time from diagnosis to esophageal button battery removal.



      Esophageal button battery ingestion is a significant problem that can lead to significant complications such as tracheoesophageal fistula, esophageal perforation, and aortoesophageal fistula. Due to this, prompt recognition and treatment is integral in the care of these patients.


      Patients who presented to a single institution from August 2015 to September 2019 with esophageal button battery ingestion were included in this study. All esophageal button battery ingestion patients were included in a clinical algorithm for Critical Airway Response Team (CART) activation in October 2019. Time from diagnosis to treatment was compared for pre-CART clinical algorithm implementation to post-CART.


      Data on pre-CART patients (n=6) and post-CART patients (n=7) was collected. Including esophageal button battery ingestions to CART activations shortened the time from chest x-ray to button battery removal from 73±32 minutes to 35±11 minutes (p<0.05).


      These data highlight the importance of implementation of a clinical care algorithm to shorten the time from diagnosis to treatment in patients with esophageal button battery ingestion.

      Level of Evidence



      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'


      Subscribe to Journal of Pediatric Surgery
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


        • Jatana K.R.
        • Litovitz T.
        • Reilly J.S.
        • et al.
        Pediatric button battery injuries: 2013 task force update.
        International Journal of Pediatric Otorhinolaryngology. 2013; 77: 1392-1399
      1. Tiny Batteries Pose Sizeable Risks, (2022). National Safety Council.

        • Leinwand K.
        • Brumbaugh D.E.
        • Kramer R.E.
        Button Battery Ingestion in Children.
        Gastrointestinal Endoscopy Clinics of North America. 2016; 26: 99-118
        • Litovitz T.
        • Whitaker N.
        • Clark L.
        • et al.
        Emerging button-ingestion hazard: clinical implications.
        Pediatrics. 2019; 125: 1168-1777
        • Laulicht B.
        • Traverso G.
        • Deshpande V.
        • et al.
        Simple battery armor to protect against gastrointestinal injury from accidental ingestion.
        Proceedings of the National Academy of Sciences. 2014; 111: 16490-16495
        • Eck J.B.
        • Ames W.A.
        Anesthetic Implications of Button Battery Ingestion in Children.
        Anesthesiology. 2020; 132: 917-924
      2. Rivera, E.A., Maves, M.D., Effects of Neutralizing Agents on Esophageal Burns Caused by Disc Batteries, 1987.

      3. Campbell, Brendan., Pellow Samantha. Esophageal Button Battery Clinical Management Algorithm. Connecticut Children’s; 2021.

        • Sethia R.
        • Gibbs H.
        • Jacobs I.N.
        Current management of button battery injuries.
        Laryngoscope Investigative Otolaryngology. 2021; 6: 549-563