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A Novel Rescue Technique for Difficult Intubation and Difficult Ventilation
Published on: January 17, 2011
Out-of-hospital pediatric airway management in the United States
Matthew Hansen1, William Lambert2, Jeanne-Marie Guise3
1Department of Emergency Medicine, Oregon Health & Science University, United States.
Insights
Pediatric out-of-hospital advanced airway procedures are uncommon. Endotracheal intubation success rates are lowest in infants under 12 months old, highlighting a critical area for improved emergency care.
Area of Science:
- Emergency Medicine
- Pediatric Critical Care
- Health Services Research
Background:
- Pediatric out-of-hospital airway management is crucial for patient survival.
- Data on the frequency, success, and complications of these interventions is limited.
- Understanding these factors is vital for improving pediatric emergency care.
Purpose of the Study:
- To characterize pediatric out-of-hospital airway management interventions.
- To determine success rates and identify complications associated with these procedures.
- To analyze data using the 2012 National Emergency Medical Services Information System (NEMSIS) dataset.
Main Methods:
- Analysis of the 2012 NEMSIS dataset, including over 949,000 pediatric patient care events.
- Identification of patients under 18 requiring airway interventions (e.g., endotracheal intubation, BVM, CPAP/BiPAP, alternate airways).
- Comparison of success and complication rates across pediatric age groups, race, ethnicity, clinical condition, and geographic region.
Main Results:
- Airway management procedures were performed in 4.5% of pediatric events.
- Invasive airway management occurred in 1.5% of events, with 29.9% of these patients being under 1 year old.
- Overall endotracheal intubation success was 81.1%, with lower rates in infants (72.1%) and those in cardiac arrest (75.5%).
Conclusions:
- Out-of-hospital advanced airway procedures in children are performed infrequently.
- The lowest success rates for endotracheal intubation were observed in infants aged 1-12 months.
- Further research and targeted interventions are needed to improve outcomes for this vulnerable population.
Objective:
The objective of this study was to characterize pediatric out-of-hospital airway management interventions, success rates, and complications in the United States using the 2012 National Emergency Medical Services Information System (NEMSIS) dataset.
Methods:
In 2012, NEMSIS collected data from Emergency Medical Services (EMS) encounters in 40 states. We included all patients less than 18 years of age and identified all patients who had airway interventions including endotracheal intubation (ETI), bag-valve-mask ventilation (BVM), continuous positive airway pressure/bilevel positive airway pressure (CPAP/BiPAP) and alternate airways (Combitube, King LT, Laryngeal Mask Airway (LMA), esophageal obturator airway, and cricothyroidotomy). Success and complication rates were analyzed and compared across pediatric age groups, by race, ethnicity, clinical condition, and geographic region.
Results:
We identified a total of 949,301 pediatric patient care events in the NEMSIS 2012 dataset. 4.5% had airway management procedures (42,936 events). Invasive airway management or ventilation (ETI, cricothyroidotomy, alternate airway, CPAP/BiPAP, BVM and other ventilation) took place in 1.5% of patient care events (14,107). Of those who had invasive airway management, 29.9% were less than 1 year of age, 58.1% were male, 42.3% were white, and 83.6% were in urban areas. ETI occurred in 3124 of patient care events (329 per 100,000; 95% CI 318-341). Overall success of ETI was 81.1% (95% CI 79.7-82.6). Lower success was noted in patients with cardiac arrest (75.5%, 95% CI 72.6-78.3) and those aged 1-12 months (72.1%, 95% CI 68.3-75.6).
Conclusions:
Out-of-hospital pediatric advanced airway procedures were infrequently performed. Success rates are lowest in patients aged 1-12 months.
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