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A Novel Rescue Technique for Difficult Intubation and Difficult Ventilation
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Pediatric Prehospital Advanced Airway Management by Anesthesiologist and Nurse Anesthetist Staffed Critical Care

Mattias Renberg1, Daniel Hertzberg2,3, Daniel Kornhall4,5

  • 1Department of Anesthesiology and Intensive Care, Södersjukhuset, Stockholm, Sweden.

Prehospital and Disaster Medicine
|July 13, 2021
PubMed

Insights

Prehospital tracheal intubation (TI) in children is challenging but achievable with experienced critical care teams, showing high success rates and low complications. This vital intervention ensures better outcomes for pediatric patients in emergency situations.

Area of Science:

  • Emergency Medicine
  • Pediatric Critical Care
  • Airway Management

Background:

  • Prehospital pediatric tracheal intubation (TI) is a critical, life-saving procedure.
  • Pediatric airway physiology presents unique challenges for intubation.
  • The incidence of prehospital pediatric TI is relatively low, requiring specialized expertise.

Purpose of the Study:

  • To characterize the demographics and outcomes of prehospital TI in pediatric patients.
  • To evaluate the effectiveness of critical care teams in managing pediatric airways.
  • To identify success rates and complications associated with pediatric prehospital intubation.

Main Methods:

  • Sub-group analysis of pediatric patients (<16 years) from a prospective, observational, multi-center study.
  • Data collected on prehospital advanced airway management in Nordic countries (May 2015-Nov 2016).
  • Intubations performed by highly experienced anesthesiologists and nurse anesthetists from helicopter and Rapid Response Car critical care teams.

Main Results:

  • 74 pediatric patients underwent tracheal intubation (3.7% of total).
  • Providers had extensive experience (80% with ≥2,500 TI).
  • Overall TI success rate was 98%, first-pass success 82%, with a 12% complication rate. Infants (<2 years) showed 94% success, 67% first-pass, and 11% complications. Median on-scene time was 30 minutes.

Conclusions:

  • High success rates (98%) for prehospital pediatric TI were achieved.
  • Complications were relatively low (12%) despite pediatric airway challenges.
  • Experienced critical care teams demonstrate effective prehospital airway management for children.
Abstract

Keywords:
Emergency Medical Servicesairway managementpediatricprehospitaltracheal intubation

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