Analysis of Out-of-Hospital Pediatric Intubation by an Australian Helicopter Emergency Medical Service

Area of Science:

• Emergency Medicine
• Pediatric Critical Care
• Aviation Medicine

Background:

• Pediatric intubation in emergency settings presents unique challenges.
• Helicopter emergency medical services (EMS) provide critical care for pediatric patients outside of hospital facilities.
• Assessing first-look success rates is crucial for evaluating the effectiveness of prehospital airway management.

Purpose of the Study:

• To evaluate the first-look success rate of emergency pediatric intubation performed by a physician-staffed helicopter EMS.
• To compare the success rates across different provider backgrounds (registrars, consultants, paramedics).
• To identify the complication rate and characteristics of difficult airways in this population.

Main Methods:

• A retrospective database analysis of pediatric (<16 years) intubations was conducted over a 64-month period.
• Data were collected from a prospectively enrolled electronic airway registry.
• Patient demographics, operator background, airway intervention details, complications, and timings were recorded.

Main Results:

• A total of 82 pediatric patients underwent intubation, with an overall first-look success rate of 91% (75/82).
• Success rates varied by provider: registrars (100%), consultants (94%), and paramedics (85%).
• The overall complication rate was 14%, with 77% of patients presenting with difficult airway indicators.

Conclusions:

• Physician-staffed helicopter EMS teams achieve a high first-look success rate for pediatric intubation.
• These prehospital success rates are comparable to those reported in pediatric emergency departments and critical care units.
• This highlights the capability of helicopter EMS in managing complex pediatric airways in the field.