Hostname: page-component-cd9895bd7-jkksz Total loading time: 0 Render date: 2024-12-25T06:11:03.271Z Has data issue: false hasContentIssue false
  • English
  • Français

Prehospital Airway Management Examined at Two Pediatric Emergency Centers

Published online by Cambridge University Press:  31 October 2018

Jefferson Tweed Open the ORCID record for Jefferson Tweed [Opens in a new window] ,
Taylor George ,
Cynthia Greenwell  and
Lori Vinson
Jefferson Tweed*
Affiliation:
Trauma Services, Children’s Health, Dallas, TexasUSA
Taylor George
Affiliation:
Trauma Services, Children’s Health, Dallas, TexasUSA Arizona Department of Health Services, Phoenix, ArizonaUSA
Cynthia Greenwell
Affiliation:
Trauma Services, Children’s Health, Dallas, TexasUSA
Lori Vinson
Affiliation:
Trauma Services, Children’s Health, Dallas, TexasUSA
*
Correspondence: Jefferson Tweed, MS Children’s Health Trauma Services 1935 Medical District Drive Dallas, Texas 75235 USA E-mail: [email protected]
Get access Rights & Permissions [Opens in a new window]

Abstract

Introduction

Routine advanced airway usage by Emergency Medical Services (EMS) has had conflicting reports of being the secure airway of choice in pediatric patients.

Hypothesis/Problem

The primary objective was to describe a pediatric cohort requiring airway management upon their arrival directly from the scene to two pediatric emergency departments (PEDs). A secondary objective included assessing for associations in EMS airway management and patient outcomes.

Methods

Retrospective data from the health record were reviewed, including EMS reports, for all arrivals less than 18 years old to two PEDs who required airway support between May 2015 and July 2016. The EMS management was classified as basic (oxygen, continuous positive airway pressure [CPAP], or bag-valve-mask [BVM]) or advanced (supraglottic or endotracheal intubation [ETI]) based on EMS documentation. Outcomes included oxygenation as documented by receiving PED and hospital mortality.

Results

In total, 104 patients with an average age 5.9 (SD=5.1) years and median EMS Glasgow Coma Scale (GCS) of nine (IQR 3-14) were enrolled. Basic management was utilized in 70% of patients (passive: n=49; CPAP: n=2; BVM: n=22). Advanced management was utilized in 30% of patients (supraglottic: n=4; ETI: n=27). Proper ETI placement was achieved in 48% of attempted patients, with 41% of patients undergoing multiple attempts. Inadequate oxygenation occurred in 18% of patients, including four percent of ETI attempts, nine percent of BVM patients, and 32% of passively managed patients. Adjusted for EMS GCS, medical patients undergoing advanced airway management experienced higher risk of mortality (risk-ratio [RR] 2.98; 95% CI, 1.18-7.56; P=.021).

Conclusion

With exception to instances where ETI is clearly indicated, BVM management is effective in pediatric patients who required airway support, with ETI providing no definitive protective factors. Most of the patients who exhibited inadequate oxygenation upon arrival to the PED received only passive oxygenation by EMS.

TweedJ, GeorgeT, GreenwellC, VinsonL.Prehospital Airway Management Examined at Two Pediatric Emergency Centers. Prehosp Disaster Med. 2018;33(5):532–538.

Keywords

airway managementEmergency Medical Servicesintubation/intra-trachealpediatric emergency medicinetreatment outcomes
Type
Original Research
Information
Prehospital and Disaster Medicine , Volume 33 , Issue 5 , October 2018 , pp. 532 - 538
Copyright
© World Association for Disaster and Emergency Medicine 2018 

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

Footnotes

Conflicts of interest: The authors report no conflicts of interest.

References

1. Fevang, E, Perkins, Z, Lockey, D, Jeppesen, E, Lossius, HM. A systematic review and meta-analysis comparing mortality in prehospital tracheal intubation to emergency department intubation in trauma patients. Critical Care. 2017;21(1):192.Google Scholar
2. Jacobs, PE, Grabinsky, A. Advances in prehospital airway management. Int J Crit Illn Inj Sci. 2014;4(1):57-64.Google Scholar
3. Lockey, DJ, Crewdson, K, Lossius, HM. Prehospital anesthesia: the same but different. British Journal of Anaesthesia. 2014;113(2):211-219.Google Scholar
4. Pepe, PE, Roppolo, LP, Fowler, RL. Prehospital endotracheal intubation: elemental or detrimental? Critical Care. 2015;19:121.Google Scholar
5. Bernhard, M, Mohr, S, Weigand, MA, Martin, E, Walther, A. Developing the skill of endotracheal intubation: implication for emergency medicine. Acta Anesthesiol Scand. 2012;56(2):164-171.Google Scholar
6. Mitchell, MS, White, ML, King, WD, Wang, HE. Paramedic King Laryngeal Tube airway insertion versus endotracheal intubation in simulated pediatric respiratory arrest. Prehosp Emerg Care. 2012;16(2):284-288.Google Scholar
7. Brownstein, D, Shugerman, R, Cummings, P, Rivara, F, Copass, M. Prehospital endotracheal intubation of children by paramedics. Ann Emerg Med. 1996;28(1):34-39.Google Scholar
8. Katz, SH, Falk, JL. Misplaced endotracheal tubes by paramedics in an urban Emergency Medical Services system. Ann Emerg Mede. 2001;37(1):32-36.Google Scholar
9. Cooper, A, DiScala, C, Foltin, G, Tunik, M, Markenson, D, Welborn, C. Prehospital endotracheal intubation for severe head injury in children: a reappraisal. Semin Pediat Surg. 2001;10(1):3-6.Google Scholar
10. Gausche, M, Lewis, RJ, Stratton, SJ, et al. Effect of out-of-hospital pediatric endotracheal intubation on survival and neurological outcome: a controlled clinical trial. JAMA. 2000;283(6):783-790.Google Scholar
11. Ostermayer, DG, Gausche-Hill, M. Supraglottic airways: the history and current state of prehospital airway adjuncts. Prehosp Emerg Care. 2013;18(1):106-115.Google Scholar
12. Anaconda Distribution for Python Website. https://www.anaconda.com/download/. Accessed January, 2018.Google Scholar
13. Seabold, S, Perktold, J. Statsmodels: econometric and statistical modeling with Python. Proceedings of the 9th Python in Science Conference. Austin, Texas USA; 2010:57-61.Google Scholar
14. Cummings, P. The relative merits of risk ratios and odds ratios. Arch Pediatr Adolesc Med. 2009;163(5):438-445.Google Scholar
15. Levitan, RM. Patient safety in emergency airway management and rapid sequence intubation: metaphorical lessons from skydiving. Ann Emerg Med. 2003;42(1):81-87.Google Scholar
16. Tollefsen, WW, Brown, CA, Cox, KL, Walls, RM. Two hundred sixty pediatric emergency airway encounters by air transport personnel: a report of the Air Transport Emergency Airway Management (NEAR VI: “A-TEAM”) Project. Pediat Emerg Care. 2013;29(9):963-968.Google Scholar