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Updated: Jun 25, 2025
A Novel Rescue Technique for Difficult Intubation and Difficult Ventilation
Published on: January 17, 2011
A Descriptive Analysis of Air Medical Pediatric Rapid Sequence Intubation: Successes and Opportunities
Daniel P Davis1, Kira Chandran2, Jennifer Noce3
1Logan Health, Division of EMS, Kalispell, MT; Air Methods Corporation, Greenwood Village, CO.
Insights
Air medical crews achieve high success rates in pediatric rapid sequence intubation (RSI). Younger children experienced lower success and device utilization, suggesting areas for improved preoxygenation and technique.
Area of Science:
- Emergency Medicine
- Pediatric Critical Care
- Air Medical Services
Background:
- Advanced airway management, including rapid sequence intubation (RSI), is critical in resuscitation.
- Pediatric airway management data, especially from emergency air medical settings, is limited due to infrequent procedures.
Purpose of the Study:
- To document the experience with pediatric RSI in a large air medical database.
- To identify opportunities for improving pediatric airway management outcomes.
Main Methods:
- Analysis of 1,091 pediatric patients (<18 years) undergoing RSI by air medical crews (2015-2019).
- Patients were stratified into age subgroups: 0-2, 3-8, and 9-17 years.
- Key outcomes included overall intubation success, first-attempt success, and first-attempt success without desaturation; preoxygenation methods and desaturation rates were also examined.
Main Results:
- Overall pediatric RSI success rate was 98%, with 91% on the first attempt and 87% without desaturation.
- Intubation success declined significantly when preoxygenation SpO2 was <97%.
- Younger patients (0-2 years) showed lower initial SpO2, reduced first-attempt success rates, and less use of PPV, video laryngoscopy, or bougie.
Conclusions:
- Air medical pediatric RSI demonstrates high success rates.
- Higher SpO2 targets during preoxygenation may be beneficial.
- Younger pediatric patients require tailored approaches, with lower rates of advanced airway adjunct use observed.
Objective:
Advanced airway management, including the use of rapid sequence intubation (RSI), is fundamental in resuscitation. However, the reported experience with pediatric airway management is limited because of the relatively low number of emergency RSI procedures in children. The aim of this study was to document the experience with pediatric RSI in a large air medical database and explore opportunities for improvement.
Methods:
All pediatric patients (age < 18 years) undergoing RSI by air medical crews between 2015 and 2019 were included in this analysis. Subjects were divided a priori into 3 age subgroups (0-2 years, 3-8 years, and 9-17 years). The primary variables of interest included overall intubation success, first-attempt intubation success, and first-attempt intubation success without desaturation. The rates of positive-pressure ventilation (PPV) use for preoxygenation and oxygen desaturation were also explored.
Results:
A total of 1,091 pediatric RSI patients were included. The overall intubation success rate was 98% (0-2 years = 96%, 3-8 years = 97%, and 9-17 years = 98%), with 91% intubated on the first attempt (0-2 years = 86%, 3-8 years = 90%, and 9-17 years = 92%) and 87% intubated on the first attempt without oxygen desaturation (0-2 years = 80%, 3-8 years = 88%, and 9-17 years = 90%). A sharp decline in intubation success was observed with preoxygenation SpO2 values < 97% across all patients. Younger patients (0-2 years) had lower initial SpO2 values and decreased first-attempt success rates with and without desaturation. These patients were less likely to receive PPV during preoxygenation attempts and had lower use of video laryngoscopy or a bougie on the initial intubation attempt.
Conclusion:
In this study, we documented high success rates for air medical pediatric RSI. Higher target SpO2 values may be justified during preoxygenation. Intubation success, PPV use for preoxygenation, video laryngoscopy, and the use of a bougie were lower for younger patients.
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