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Pediatric Prehospital Emergency Anesthesia First-Pass Success Rates in a United Kingdom Enhanced Prehospital Care
Megan Pode1, Georgia Ann Clarke2, Hilary Ann Eason3
1Royal Manchester Children's Hospital, Manchester.
Insights
Pediatric prehospital emergency anesthesia (PHEA) achieved a 96% first-pass success rate in a UK air ambulance service, demonstrating high safety and effectiveness. This finding supports continued investment in training and service design for this critical intervention.
Area of Science:
- Emergency Medicine
- Pediatric Anesthesia
- Prehospital Care
Background:
- Prehospital emergency anesthesia (PHEA) is vital for critically ill children but carries risks.
- Some services restrict pediatric PHEA due to challenges.
Purpose of the Study:
- To evaluate first-pass success (FPS) rates of pediatric PHEA by the North West Air Ambulance (NWAA).
Main Methods:
- Retrospective analysis of 161 pediatric patients (0-15 years) undergoing drug-assisted intubation by NWAA from April 2018 to April 2025.
- Primary outcome: FPS, defined as successful tracheal intubation on the first attempt.
Main Results:
- Pediatric PHEA achieved 96% FPS, with all patients intubated within 3 attempts.
- Infants and children aged 0-5 years had a 95% FPS rate.
- Adult prehospital RSI in the same period had an 88% FPS rate.
Conclusions:
- High FPS rates for pediatric PHEA are achievable in well-trained, consultant-led services.
- Pediatric PHEA is safe and effective with senior clinician support, robust training, and governance.
- Focus should be on training and service improvement, not limiting PHEA.
Objectives:
Prehospital emergency anesthesia (PHEA) is a critical intervention in pediatric prehospital emergency medicine but presents risks and unique challenges. Consequently, some services limit the provision of this practice. This study aimed to determine first-pass success (FPS) rates for pediatric PHEA delivered by the North West Air Ambulance (NWAA) service in the United Kingdom.
Methods:
A 7-year retrospective analysis (April 3, 2018 to April 10, 2025) of pediatric PHEA cases managed by NWAA was conducted using a standardized quality database. All patients aged 0 to 15 years who underwent drug-assisted intubation were included. The primary outcome was FPS, defined as successful tracheal intubation on the first attempt.
Results:
During the study period, 1742 patients attended by NWAA underwent PHEA in the prehospital setting, of whom 161 were pediatric patients aged 0 to 15 years. In all, 96 pediatric patients underwent RSI. FPS was achieved in 96% of these patients, with all patients successfully intubated within a maximum of 3 attempts. Patients between 0 and 5 years had 95% FPS. For context, 1441 adults underwent prehospital RSI in the same period, with an FPS rate of 88%.
Conclusions:
This study demonstrates that FPS rates for children undergoing PHEA in a well-trained, consultant-led prehospital service can be high, exceeding those reported in adults. Our findings provide reassurance that pediatric PHEA can be delivered safely and effectively when supported by senior clinicians, robust training, and rigorous governance. Concerns regarding FPS in children should focus on continued investment in training, service design, and audit, rather than limiting PHEA as a life-saving intervention. Further research is needed to assess whether these results are reproducible in other services, non-PHEA intubations, and across wider clinical outcomes.
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