Related Experiment Videos
Prehospital pediatric endotracheal intubation performance review
J D Losek1, W A Bonadio, C Walsh-Kelly
1Department of Pediatrics, Medical College of Wisconsin, Children's Hospital of Wisconsin, Milwaukee 53233.
Insights
Pediatric endotracheal intubation by paramedics was successful in 78% of cases. Key challenges included airway visualization and equipment size, particularly in pulseless nonbreathing patients.
Area of Science:
- Emergency Medicine
- Pediatric Critical Care
Background:
- Prehospital endotracheal intubation is a critical intervention for pediatric patients.
- Understanding success rates and challenges is vital for improving outcomes.
Purpose of the Study:
- To evaluate the success rate of pediatric endotracheal intubation by paramedics.
- To identify causes of unsuccessful intubations and associated complications.
Main Methods:
- Retrospective review of pediatric prehospital care over one year.
- Analysis of 1467 pediatric patient calls, focusing on 63 requiring endotracheal intubation.
Main Results:
- Overall success rate for pediatric endotracheal intubation was 78% (49/63).
- Success rates varied by patient condition: 93% for pulseless nonbreathing (PNB) and 48% for impending respiratory failure.
- Common difficulties included poor glottic visualization, incorrect tube size, and accidental extubation.
Conclusions:
- Paramedic endotracheal intubation in pediatric patients has a moderate success rate.
- Training should address specific challenges encountered, especially in PNB and respiratory failure cases.
- Ongoing performance monitoring and review are recommended for prehospital pediatric intubation.
Abstract:
Pediatric prehospital care was reviewed over a one-year period to determine success rate, causes of unsuccessful attempts, and complications of performing endotracheal intubation. The Milwaukee County Emergency Medicine Technician-Paramedics (EMT-Ps) responded to 1467 pediatric (less than 19 years of age) patient calls. This accounted for 11% of the patients who received EMT-P care during the study period. Of the 63 patients requiring pediatric endotracheal intubation, 49 (78%) were successfully intubated. Of the 42 pulseless nonbreathing (PNB) patients, 39 (93%) were successfully Of the 21 patients judged to be in impending respiratory failure, 10 (48%) were successfully intubated. Common difficulties in intubating the PNB patient included inability to visualize the glottis and cords secondary to mucus and/or vomitus, use of inappropriately small endotracheal tubes, and accidental extubation during transport. Difficulties in intubating impending respiratory failure patients included patient resistance and seizure activity. We recommend that the EMT-P training curriculum include a review of these difficulties and that prehospital pediatric endotracheal intubation performance be monitored and reviewed with the EMT-Ps.