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Endotracheal intubation of pediatric patients by paramedics
1Department of Emergency Medicine, Valley Medical Center, Fresno, California 93702.
Insights
Prehospital endotracheal intubation in pediatric patients had a 64% success rate but a 7% major complication rate. Survival to discharge was low at 6% for successfully intubated children.
Area of Science:
- Emergency Medicine
- Pediatric Critical Care
Background:
- Limited research exists on prehospital endotracheal intubation in pediatric patients.
- Adult prehospital intubation is more widely studied.
Purpose of the Study:
- Assess the frequency of pediatric prehospital endotracheal intubation.
- Determine success rates and complications of field intubation.
- Compare outcomes of intubated versus non-intubated pediatric arrest patients.
Main Methods:
- Retrospective study over 38 months.
- Included pediatric medical cardiopulmonary arrest victims (<19 years).
- Data from field forms, hospital charts, and death records.
Main Results:
- 66% of eligible pediatric patients had intubation attempted.
- Successful intubation rate was 64% with 7% major complications.
- Infants (<1 year) had lower intubation attempt (38%) and success (50%) rates.
- 50% of successfully intubated patients survived to hospital admission; 6% survived to discharge.
Conclusions:
- Prehospital endotracheal intubation in pediatric cardiac arrest is feasible but carries risks.
- Success rates and survival outcomes require further investigation.
- Outcomes are particularly concerning in infants.
Abstract:
Although a number of studies have described endotracheal intubation of adult patients in the prehospital setting, there are few studies on prehospital endotracheal intubation of pediatric patients. The purposes of our study were to determine how frequently prehospital endotracheal intubation was used in pediatric cardiopulmonary arrests when a paramedic trained in endotracheal intubation was present, to determine the success rate and complications associated with the procedure in the field, and to compare resuscitation rates and outcome in patients with and without prehospital endotracheal intubation. Our retrospective study covered a 38-month period and included all prehospital victims of medical cardiopulmonary arrest under the age of 19 years. Data were collected from field assessment forms and validated by hospital charts, autopsy reports, coroner's reports, death certificates, and emergency medical services central dispatch logs. Of 63 victims of medical cardiorespiratory arrest, 42 had intubating paramedics present at the scene. Twenty-eight of 42 patients (66%) had endotracheal intubation attempted. Eighteen of 28 attempts (64%) were successful, associated with a major complication rate of 7% (two of 28) and a minor complication rate of 39% (11 of 28). In patients less than 1 year old, only six of 16 (38%) had endotracheal intubation attempted and only three of six (50%) attempts were successful. Of the 18 patients who were intubated successfully before arrival at the hospital, nine (50%) survived to hospital admission and one (6%) survived to discharge. The remainder died in the emergency department.(ABSTRACT TRUNCATED AT 250 WORDS)