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Updated: Jun 29, 2025
Guidelines for Elective Pediatric Fiberoptic Intubation
Published on: January 17, 2011
Paramedics' Success and Complications in Prehospital Pediatric Intubation: A Meta-Analysis
Faisal A AlGhamdi1, Nasser A AlJoaib1, Abdulaziz M Saati1
1College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia.
Insights
Paramedics achieve a high success rate in prehospital pediatric intubation. Utilizing muscle relaxants significantly improves intubation success and reduces complications in children.
Area of Science:
- Emergency Medicine
- Pediatric Critical Care
Background:
- Prehospital pediatric intubation is crucial but challenging due to pediatric anatomy.
- Adverse events are a concern, necessitating assessment of paramedic performance.
- This study evaluates paramedic knowledge and attitudes through success rates and complication analysis.
Purpose of the Study:
- To assess the overall success rate of prehospital pediatric intubation by paramedics.
- To identify and analyze complications associated with this procedure.
- To evaluate the impact of muscle relaxants on intubation outcomes.
Main Methods:
- A systematic literature search was performed across major databases (PubMed, Scopus, Web of Science, Cochrane CENTRAL).
- Studies were screened for eligibility, and data were extracted.
- Pooled analysis using risk ratios (RR) and 95% confidence intervals (CI) was conducted.
Main Results:
- The meta-analysis included 38 studies with 14,207 pediatric patients.
- Overall intubation success rate was 82.5% (95% CI, 0.745-0.832), with 77.2% success on the first attempt.
- Use of muscle relaxants was associated with higher success rates (92.5% overall, 79.9% first attempt) compared to non-use (78.9% overall, 73.3% first attempt).
Conclusions:
- Paramedics demonstrate a favorable success rate in prehospital pediatric intubation.
- Complication rates are generally low.
- The use of muscle relaxants is associated with improved intubation success rates in pediatric patients.
Background:
Prehospital pediatric intubation is a potentially life-saving procedure in which paramedics are relied upon. However, due to the anatomical nature of pediatrics and associated adverse events, it is more challenging compared to adult intubation. In this study, the knowledge and attitude of paramedics was assessed by measuring their overall success rate and associated complications.
Methods:
An online search using PubMed, Scopus, Web of Science, and Cochrane CENTRAL was conducted using relevant keywords to include studies that assess success rates and associated complications. Studies for eligibility were screened. Data were extracted from eligible studies and pooled as risk ratio (RR) with a 95% confidence interval (CI).
Results:
Thirty-eight studies involving 14,207 pediatrics undergoing intubation by paramedics were included in this study. The prevalence of success rate was 82.5% (95% CI, 0.745-0.832) for overall trials and 77.2% (95% CI, 0.713-0.832) success rate after the first attempt. By subgrouping the patients according to using muscle relaxants during intubation, the group that used muscle relaxants showed a high overall successful rate of 92.5% (95% CI, 0.877-0.973) and 79.9% (95% CI, 0.715-0.994) success rate after the first attempt, more than the group without muscle relaxant which represent 78.9% (95% CI, 0.745-0.832) overall success rate and 73.3% (95% CI, 0.616-0.950) success rate after first attempt.
Conclusion:
Paramedics have a good overall successful rate of pediatric intubation with a lower complication rate, especially when using muscle relaxants.
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