Intubation During Pediatric Cardiac Arrest in the Emergency Department Is Associated With Reduced First-Pass Success

Area of Science:

• Pediatric Emergency Medicine
• Critical Care
• Airway Management

Background:

• Airway compromise and respiratory failure are primary causes of pediatric cardiac arrest.
• First-pass success (FPS) in advanced airway management is linked to improved patient outcomes.
• Limited data exists on advanced airway management during pediatric out-of-hospital cardiac arrest (OHCA) in the emergency department (ED).

Purpose of the Study:

• To compare the first-pass success (FPS) rates of advanced airway management in pediatric patients experiencing OHCA versus those not in cardiac arrest within the ED.

Main Methods:

• Analysis of prospectively recorded pediatric intubations in an academic pediatric ED over 12 years (July 2007-June 2019).
• Inclusion criteria: All patients under 18 years undergoing ED intubation.
• Primary outcome: Comparison of FPS in OHCA versus non-cardiac arrest patients; logistic regression used to identify factors associated with FPS in OHCA.

Main Results:

• A total of 608 pediatric patients were intubated; 103 with OHCA and 459 without.
• FPS was achieved in 47.6% of OHCA patients compared to 75.4% of non-cardiac arrest patients.
• Cardiac arrest was independently associated with a reduced likelihood of FPS (adjusted odds ratio 0.44).

Conclusions:

• Pediatric OHCA is associated with significantly lower first-pass success rates for intubation in the ED.
• Rescuers should focus on optimizing oxygenation, ventilation, and intubation conditions prior to advanced airway attempts in pediatric OHCA patients.