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Updated: Mar 24, 2026
Guidelines for Elective Pediatric Fiberoptic Intubation
Published on: January 17, 2011
Factors Associated with First-Pass Success in Pediatric Intubation in the Emergency Department
Tadahiro Goto1, Koichiro Gibo2, Yusuke Hagiwara3
1Massachusetts General Hospital, Department of Emergency Medicine, Boston, Massachusetts.
Insights
Older children, rapid sequence intubation (RSI), and emergency physician-led intubation increase first-pass success rates in the emergency department. These factors are key for effective pediatric airway management.
Area of Science:
- Emergency Medicine
- Pediatric Critical Care
- Airway Management
Background:
- First-pass success in pediatric intubation is crucial for patient outcomes in emergency departments (EDs).
- Understanding factors influencing successful first attempts is vital for optimizing pediatric airway management strategies.
Purpose of the Study:
- To investigate independent predictors of first-pass success in pediatric endotracheal intubation within the ED setting.
- To identify key variables associated with achieving successful intubation on the first attempt in children.
Main Methods:
- Analysis of data from two multicenter prospective studies involving 293 pediatric patients undergoing ED intubation.
- Logistic regression modeling with generalized estimating equations was used to identify predictors of first-pass success.
- Sensitivity analysis was performed on children younger than 10 years.
Main Results:
- The overall first-pass success rate was 60%.
- Factors significantly associated with higher first-pass success included older age (≥10 years), use of rapid sequence intubation (RSI), and intubation by an emergency physician.
- These associations were consistent in sensitivity analyses.
Conclusions:
- Older age, rapid sequence intubation (RSI), and intubation by emergency physicians are independent predictors of successful first-pass pediatric intubation in the ED.
- These findings can inform the development of improved airway management protocols for critically-ill children.
Introduction:
The objective of this study was to investigate the factors associated with first-pass success in pediatric intubation in the emergency department (ED).
Methods:
We analyzed the data from two multicenter prospective studies of ED intubation in 17 EDs between April 2010 and September 2014. The studies prospectively measured patient's age, sex, principal indication for intubation, methods (e.g., rapid sequence intubation [RSI]), devices, and intubator's level of training and specialty. To evaluate independent predictors of first-pass success, we fit logistic regression model with generalized estimating equations. In the sensitivity analysis, we repeated the analysis in children <10 years.
Results:
A total of 293 children aged ≤18 years who underwent ED intubation were eligible for the analysis. The overall first-pass success rate was 60% (95%CI [54%-66%]). In the multivariable model, age ≥10 years (adjusted odds ratio [aOR], 2.45; 95% CI [1.23-4.87]), use of RSI (aOR, 2.17; 95% CI [1.31-3.57]), and intubation attempt by an emergency physician (aOR, 3.21; 95% CI [1.78-5.83]) were significantly associated with a higher chance of first-pass success. Likewise, in the sensitivity analysis, the use of RSI (aOR, 3.05; 95% CI [1.63-5.70]), and intubation attempt by an emergency physician (aOR, 4.08; 95% CI [1.92-8.63]) were significantly associated with a higher chance of first-pass success.
Conclusion:
Based on two large multicenter prospective studies of ED airway management, we found that older age, use of RSI, and intubation by emergency physicians were the independent predictors of a higher chance of first-pass success in children. Our findings should facilitate investigations to develop optimal airway management strategies in critically-ill children in the ED.
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