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Pre-hospital advanced airway management in children: a challenge that training can handle

Joanna B Watterson1,2, Cliff Reid3,4, Brian J Burns3,4

  • 1Greater Sydney Area Helicopter Emergency Medical Service (GSA-HEMS), New South Wales Ambulance, Sydney, NSW, Australia. Joanna.Watterson@nyumc.org.

Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine
|December 6, 2017
PubMed

Insights

Pre-hospital endotracheal intubation (PHETI) in children showed higher success rates and fewer complications with our established protocols compared to recent Danish findings. Our physician and paramedic teams achieved superior outcomes in pediatric airway management.

Area of Science:

  • Emergency Medicine
  • Pediatric Critical Care
  • Anesthesiology

Background:

  • Responding to Tarpgaard et al.'s report on pre-hospital endotracheal intubation (PHETI) in Danish critical care settings.
  • Comparing Danish PHETI outcomes (96% success, 75% first-pass success, 20% complications) in 25 children (<16 years) with our service's prior experience.
  • Highlighting the critical role of specialized medical teams in pediatric airway management.

Discussion:

  • Our service's experience with 82 pediatric patients demonstrated superior PHETI results: 100% overall success, 91% first-pass success, and 14% complications.
  • Analyzing potential contributing factors to the observed differences in PHETI outcomes between the two studies.
  • Emphasizing the importance of standardized training and operational protocols in achieving high-fidelity pediatric pre-hospital airway interventions.

Key Insights:

  • Physician and paramedic teams can achieve exceptionally high success rates in pediatric pre-hospital endotracheal intubation.
  • Established, rigorous training and operating protocols are crucial for minimizing complications and maximizing first-pass success in pediatric PHETI.
  • Our data suggests that optimized protocols can lead to better outcomes than those reported in some critical care settings.

Outlook:

  • Further research into specific training methodologies and team dynamics that enhance pediatric PHETI performance.
  • Potential for wider adoption of refined protocols to improve pediatric emergency airway management globally.
  • Continued evaluation of pre-hospital airway management techniques to ensure optimal patient care for critically ill children.

Keywords:
Out-of-hospital paediatric intubationPHETIPaediatric intubationTraining

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