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Prehospital endotracheal intubation of children by paramedics
D Brownstein1, R Shugerman, P Cummings
1Department of Pediatrics, University of Washington, Seattle, USA.
Insights
Paramedics successfully performed prehospital pediatric endotracheal intubation using liberal indications and succinylcholine. This approach allowed intubation across various pediatric ages and conditions, with over half of patients surviving to hospital discharge.
Area of Science:
- Emergency medicine
- Pediatric critical care
Background:
- Prehospital pediatric endotracheal intubation is a critical intervention.
- Liberal indications may improve outcomes but require careful evaluation.
Purpose of the Study:
- To describe the experience of an emergency medical services system using liberal indications for prehospital pediatric endotracheal intubation.
- To evaluate the safety and effectiveness of this approach.
Main Methods:
- Retrospective review of prehospital and hospital records for children (≤15 years) intubated by King County paramedics from 1984-1990.
- Analysis of patient demographics, diagnoses, physiological parameters, intubation details, and outcomes.
Main Results:
- 654 children were intubated; 355 were study patients (median age 3 years, 60% injury diagnosis).
- On arrival, 83% had Glasgow Coma Scale ≤8; 47% received succinylcholine.
- At ED arrival, 79% were in sinus rhythm, 75% had adequate BP; 22.6% experienced complications. 58% survived to discharge; 12% of cardiac arrest victims survived.
Conclusions:
- Liberal indications for pediatric intubation and use of succinylcholine enabled paramedics to intubate diverse pediatric populations.
- Close medical direction is crucial for successful prehospital pediatric endotracheal intubation.
Study Objective:
To describe the experience of an emergency medical services system with the use of liberal indications for prehospital pediatric endotracheal intubation.
Methods:
We performed a retrospective review of prehospital and hospital patient records in an urban and suburban prehospital care system. The study included all children aged 15 years or younger who were intubated in the prehospital setting by King County paramedics from January 1, 1984, to December 31, 1990.
Results:
During the 7-year study period, 654 children were intubated, of which 355 (54%) were study patients. The median age of the patients was 3 years; 60% had an injury diagnosis. On arrival of the paramedics, 60% of the patients were in sinus rhythm, 62% had a systolic blood pressure of 70 mm Hg or greater, and 56% had a respiratory rate of 10 breaths per minute or greater. The Glasgow Coma Scale score was 8 or lower in 83% of the patients. Succinylcholine was used to facilitate intubation in 47% of patients. On arrival at the emergency department, 79% of the patients were in sinus rhythm; 75% had an adequate blood pressure (70 mm Hg or greater); 86% had a PaO2 value of 100 mm Hg or greater; and 74% had a PaCO2 value of 45 mm Hg or lower. Complications of intubation, more than half of which were classified as minor, were noted in 22.6% of patients. We were unable to determine the number of failed intubation attempts. Most of the patients (58%) survived to hospital discharge. Among cardiac arrest victims, only 12% survived.
Conclusion:
In a setting where paramedics practice with close medical direction, applying liberal indications for pediatric intubation and permitting the use of succinylcholine allowed paramedics to intubate children of different ages and diagnoses.