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Don't Hold Your Breath-A Video-Based Study of Procedural Intervals During Pediatric Rapid Sequence Intubation

Ashish Shah, Katherine Edmunds, Preston Dean1

  • 1Division of Emergency Medicine, Cincinnati Children's Hospital Medical Center.

Pediatric Emergency Care
|February 1, 2022
PubMed

Insights

In pediatric rapid sequence intubation (RSI), prolonged tube delivery, not laryngoscopy, significantly extends the apneic period during unsuccessful attempts. Improving tube delivery is key for reducing apnea duration in pediatric emergency departments.

Area of Science:

  • Pediatric Emergency Medicine
  • Anesthesiology
  • Critical Care

Background:

  • Rapid sequence intubation (RSI) is a critical procedure in pediatric emergency departments (PEDs).
  • The apneic period during RSI can lead to hypoxemia, especially in children.
  • Understanding the specific contributors to the apneic period is crucial for improving patient safety.

Purpose of the Study:

  • To develop a framework for collecting data on laryngoscopy and tube delivery times during RSI in a PED.
  • To determine how these intervals contribute to the total apneic period in both successful and unsuccessful intubation attempts.
  • To identify specific areas for improvement in the RSI procedure.

Main Methods:

  • Retrospective, observational study of RSI in an academic PED.
  • Analysis of video recordings of intubation attempts by first-provider physicians.
  • Measurement of laryngoscopy and tube delivery intervals for successful and unsuccessful attempts.
  • Statistical comparison of interval durations, adjusting for age and provider clustering.

Main Results:

  • A total of 89 intubation attempts were analyzed in 69 patients.
  • Unsuccessful attempts had a significantly longer median apneic period (57 seconds) compared to successful attempts (44 seconds).
  • While laryngoscopy times were similar, tube delivery was substantially longer in unsuccessful attempts (25.5 vs. 11 seconds).

Conclusions:

  • A time-based framework was successfully developed to analyze RSI contributors to apnea.
  • Prolonged tube delivery is a major factor contributing to extended apneic periods during pediatric RSI.
  • Future quality improvement efforts in PEDs should focus on optimizing the tube delivery phase of RSI.
Abstract

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