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Published on: July 14, 2023
Prehospital Pediatric Respiratory Distress and Airway Management Interventions: An NAEMSP Position Statement and
Insights
Emergency Medical Services (EMS) should prioritize pediatric airway management with proper equipment, noninvasive ventilation, and supraglottic airways. Endotracheal intubation in pediatric emergencies requires further research and strict oversight.
Area of Science:
- Pediatric Emergency Medicine
- Critical Care
- Airway Management
Background:
- Pediatric respiratory and airway emergencies require specialized management strategies.
- Evolution of tools, technology, and evidence in pediatric EMS airway management over the past decade.
- Existing devices include bag-valve-mask ventilation, endotracheal intubation, supraglottic airways, and noninvasive ventilation.
Purpose of the Study:
- To provide recommendations for optimal pediatric airway management in the Emergency Medical Services (EMS) setting.
- To guide EMS clinicians and agencies on the use of various airway management tools and techniques for pediatric patients.
- To address the evolving landscape of pediatric emergency airway interventions.
Main Methods:
- Development of recommendations based on current evidence and expert consensus.
- Emphasis on age-appropriate equipment sizing, availability, and maintenance.
- Training and equipping clinicians with advanced monitoring tools like pulse oximetry and capnography.
- Focus on noninvasive positive pressure ventilation and bag-valve-mask ventilation strategies.
- Evaluation of supraglottic airways and endotracheal intubation in pediatric EMS.
Main Results:
- Recommends readily available, properly sized, and clearly identified pediatric equipment for all EMS clinicians.
- Advocates for training and equipping clinicians with age-appropriate pulse oximetry and capnography.
- Emphasizes noninvasive positive pressure ventilation and effective bag-valve-mask ventilation for children.
- Supports the use of supraglottic airways as primary or secondary interventions for pediatric respiratory failure and cardiac arrest.
- Indicates unclear benefit for pediatric endotracheal intubation in EMS, requiring further research for advanced techniques.
Conclusions:
- EMS agencies must ensure pediatric-specific training, competency, and quality management for endotracheal intubation.
- Direct laryngoscopy with Magill forceps for foreign body removal should be maintained.
- Continued research is needed to define risks and benefits of advanced pediatric endotracheal intubation techniques before widespread implementation.
Abstract:
Devices and techniques such as bag-valve-mask ventilation, endotracheal intubation, supraglottic airway devices, and noninvasive ventilation offer important tools for airway management in critically ill EMS patients. Over the past decade the tools, technology, and strategies used to assess and manage pediatric respiratory and airway emergencies have evolved, and evidence regarding their use continues to grow.NAEMSP recommends:Methods and tools used to properly size pediatric equipment for ages ranging from newborns to adolescents should be available to all EMS clinicians. All pediatric equipment should be routinely checked and clearly identifiable in EMS equipment supply bags and vehicles.EMS agencies should train and equip their clinicians with age-appropriate pulse oximetry and capnography equipment to aid in the assessment and management of pediatric respiratory distress and airway emergencies.EMS agencies should emphasize noninvasive positive pressure ventilation and effective bag-valve-mask ventilation strategies in children.Supraglottic airways can be used as primary or secondary airway management interventions for pediatric respiratory failure and cardiac arrest in the EMS setting.Pediatric endotracheal intubation has unclear benefit in the EMS setting. Advanced approaches to pediatric ETI including drug-assisted airway management, apneic oxygenation, and use of direct and video laryngoscopy require further research to more clearly define their risks and benefits prior to widespread implementation.If considering the use of pediatric endotracheal intubation, the EMS medical director must ensure the program provides pediatric-specific initial training and ongoing competency and quality management activities to ensure that EMS clinicians attain and maintain mastery of the intervention.Paramedic use of direct laryngoscopy paired with Magill forceps to facilitate foreign body removal in the pediatric patient should be maintained even when pediatric endotracheal intubation is not approved as a local clinical intervention.
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