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Anaesthetist-provided pre-hospital advanced airway management in children: a descriptive study
Mona Tarpgaard1,2, Troels Martin Hansen3,4, Leif Rognås5,6
1Pre-hospital Critical Care Team, Aarhus University Hospital, Oluf Palmes Alle 32, Aarhus N, 8200, Denmark. montar@rm.dk.
Insights
Pediatric pre-hospital endotracheal intubation has a 96% success rate but a low first-pass success rate. Complication rates are higher in children, highlighting challenges in pediatric airway management.
Area of Science:
- Emergency Medicine
- Pediatric Critical Care
- Anesthesiology
Background:
- Pre-hospital advanced airway management is a research priority in critical care.
- Paediatric pre-hospital airway management is understudied.
- This study addresses the need for data on pediatric airway management outcomes.
Purpose of the Study:
- To investigate the success rate of pre-hospital endotracheal intubation in children.
- To determine first-pass success rates for pediatric endotracheal intubation.
- To identify complications associated with advanced airway management in pediatric patients.
Main Methods:
- Prospective descriptive study.
- Data collected from eight anaesthetist-staffed pre-hospital critical care teams.
- Study period: February 1st, 2011, to November 1st, 2012.
Main Results:
- Overall endotracheal intubation success rate was 96% in 25 children.
- First-pass success rate was 75% overall, and 54% in children under 2 years.
- Complication rates were 20% in children under 16 and 38% in those under 2.
Conclusions:
- Pediatric pre-hospital endotracheal intubation success is acceptable, but first-pass rates are low.
- Complication rates in children are higher than in the general pre-hospital population.
- Pediatric patients present unique airway management challenges for critical care teams.
Background:
Pre-hospital advanced airway management has been named one of the top-five research priorities in physician-provided pre-hospital critical care. Few studies have been made on paediatric pre-hospital advanced airway management. The aim of this study was to investigate pre-hospital endotracheal intubation success rate in children, first-pass success rates and complications related to pre-hospital advanced airway management in patients younger than 16 years of age treated by pre-hospital critical care teams in the Central Denmark Region (1.3 million inhabitants).
Methods:
A prospective descriptive study based on data collected from eight anaesthetist-staffed pre-hospital critical care teams between February 1st 2011 and November 1st 2012. Primary endpoints were 1) pre-hospital endotracheal intubation success rate in children 2) pre-hospital endotracheal intubation first-pass success rate in children and 3) complications related to prehospital advanced airway management in children.
Results:
The pre-hospital critical care anaesthetists attempted endotracheal intubation in 25 children, 13 of which were less than 2 years old. In one patient, a neonate (600 g birth weight), endotracheal intubation failed. The patient was managed by uneventful bag-mask ventilation. All other 24 children had their tracheas successfully intubated by the pre-hospital critical care anaesthetists resulting in a pre-hospital endotracheal intubation success rate of 96 %. Overall first pass success-rate was 75 %. In the group of patients younger than 2 years old, first pass success-rate was 54 %. The total rate of airway management related complications such as vomiting, aspiration, accidental intubation of the oesophagus or right main stem bronchus, hypoxia (oxygen saturation < 90 %) or bradycardia (according to age) was 20 % in children younger than 16 years of age and 38 % in children younger than 2 years of age. No deaths, cardiac arrests or severe bradycardia (heart rate <60) occurred in relation to pre-hospital advanced airway management.
Conclusion:
Compared with the total population of patients receiving pre-hospital advanced airway management in our system, the overall success rate following pre-hospital endotracheal intubations in children is acceptable but the first-pass success rate is low. The complication rates in the paediatric population are higher than in our pre-hospital advanced airway management patient population as a whole. This illustrates that young children may represent a substantial pre-hospital airway management challenge even for experienced pre-hospital critical care anaesthetists. This may influence future training and quality insurance initiatives in paediatric pre-hospital advanced airway management.
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