Intubation practice and outcomes among pediatric emergency departments: A report from National Emergency Airway Registry for Children (NEAR4KIDS)

Capone, Christine A.; Emerson, Beth; Sweberg, Todd; Polikoff, Lee; Turner, David A.; Adu‐Darko, Michelle; Li, Simon; Glater-Welt, Lily; Howell, Joy; Brown, Calvin A.; Donoghue, Aaron; Krawiec, Conrad; Shults, Justine; Breuer, Ryan; Swain, Kelly; Shenoi, Asha; Krishna, Ashwin; Al‐Subu, Awni; Harwayne‐Gidansky, Ilana; Biagas, Katherine; Kelly, Serena; Nuthall, Gabrielle; Panisello, Josep; Napolitano, Natalie; Giuliano, John S.; Émériaud, Guillaume; Toedt‐Pingel, Iris; Lee, Anthony; Page-Goertz, Christopher; Kimura, Dai; Kasagi, Mioko; D'Mello, J.; Parsons, Simon; Mallory, Palen; Gima, Masafumi; Bysani, G. Kris; Motomura, Makoto; Tarquinio, Keiko M.; Nett, Sholeen; Ikeyama, Takanari; Shetty, Rakshay; Sanders, Ronald C.; Lee, Jan Hau; Pinto, Matthew; Orioles, Alberto; Jung, Philipp; Shlomovich, Mark; Nishisaki, Akira

doi:10.1111/acem.14431

Cited by 19 publications

(30 citation statements)

References 29 publications

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“…For this study, we opted to use an infant airway manikin because a quarter of intubated children are infants, and 40% of intubations are in children younger than 2 years of age 2 . It is also in the under 1‐year‐old group where most difficult airways and intubation‐related adverse events occur 4,6,7 . Further studies should be undertaken in alternative airway models with an older chronological age to investigate the performance of the adjuncts in older pediatric age groups.…”

Section: Resultsmentioning

confidence: 99%

“…2 It is also in the under 1-year-old group where most difficult airways and intubationrelated adverse events occur. 4,6,7 Further studies should be undertaken in alternative airway models with an older chronological age to investigate the performance of the adjuncts in older pediatric age groups.…”

Section: Limitationsmentioning

confidence: 99%

“…The NEAR4KIDS airway registry reported that 15.6% of courses of pediatric intubations in the ED were associated with tracheal intubation associated events (TIAEs), and 5.4% of all courses encountered severe TIAEs. 4 Examples of severe TIAEs are cardiac arrests with or without return of spontaneous circulation, esophageal intubation without immediate recognition, emesis with aspiration, and hypotension requiring interventions. Examples of non‐severe TIAEs are mainstem bronchial intubation, esophageal intubation with immediate recognition, and emesis without aspiration.…”

Section: Introductionmentioning

confidence: 99%

“…2 It is also in the under 1-year-old group where most difficult airways and TIAEs occur. 4,6,7 Despite the increase in availability of video laryngoscopy, current airway publications have shown that most intubations are undertaken with direct laryngoscopy. [7][8][9] Even when video laryngoscopy is used, an airway adjunct like stylet or bougie may still be needed.…”

Section: Introductionmentioning

confidence: 99%

“…Additionally, endotracheal intubations in pediatric patients in the ED are frequently associated with adverse events. The NEAR4KIDS airway registry reported that 15.6% of courses of pediatric intubations in the ED were associated with tracheal intubation associated events (TIAEs), and 5.4% of all courses encountered severe TIAEs 4 . Examples of severe TIAEs are cardiac arrests with or without return of spontaneous circulation, esophageal intubation without immediate recognition, emesis with aspiration, and hypotension requiring interventions.…”

Section: Introductionmentioning

confidence: 99%

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The adjuncts for endotracheal tube passage in simulated pediatric airways (AET‐SPA) study

Gan

Shepherd

2022

JACEP Open

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Objectives To investigate whether the use of adjuncts such as stylet, railroaded bougie, and preloaded bougie increases first‐pass success rate and decreases time to successful intubation when intubating simulated infant airways using direct laryngoscopy. Methods A crossover study using experienced practitioners (who were required to carry out emergency pediatric intubations as part of their usual practice) was completed. Participants completed a random sequence of 4 intubations in simulated “easy” airways and 4 intubations in simulated “difficult” airways, using naked endotracheal tube, stylet, railroaded bougie, and preloaded bougie on standardized infant airway manikins. First‐pass success rates and times to successful intubations were measured. Results From June 1 to December 30, 2019, 109 participants performed a total of 872 intubation attempts. In the easy airway, both naked endotracheal tube (mean 96.3% [95% confidence interval 90.9%–99.0%]) and stylet (mean 98.2% [95% confidence interval 93.5%–99.8%]) had higher first‐pass success rates than railroaded bougie and preloaded bougie. In the difficult airway, stylet (mean 76.1% [95% confidence interval 67.0%–83.8%]) had the highest first‐pass success rate, followed by the naked endotracheal tube, and then both the railroaded bougie and preloaded bougie. Differences in first‐pass success rates were independent of the participants’ numbers of previous pediatric intubations. Conclusion Results of this simulation‐based study suggest that stylet should be used as the first attempt technique for infant intubations regardless of the presence or absence of predicted airway difficulty. This finding needs further validation using alternative models and in non‐simulation settings.

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Section: Resultsmentioning

confidence: 99%

Section: Limitationsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 3 more Smart Citations

The adjuncts for endotracheal tube passage in simulated pediatric airways (AET‐SPA) study

Gan

Shepherd

2022

JACEP Open

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See one, see one, teach one – Decisions on allocating intubation opportunities in pediatric emergency medicine

Miller

Dechnik

Miller

et al. 2022

AEM Education and Training

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Background: Decisions about who should perform tracheal intubation in academic settings must balance the needs of trainees to develop competency in pediatric intubation with patient safety. Airway protocols during the COVID-19 pandemic may have reduced opportunities for trainees, representing an opportunity to examine the impact of shifting laryngoscopy responsibilities away from trainees. Methods: This observational study combined data from 11 pediatric emergency departments in North America participating in either the National Emergency Airway Registry for Children (NEAR4KIDS) or a national pediatric emergency medicine airway education collaborative. Sites provided information on airway protocols, patient and procedural characteristics, and clinical outcomes. For the pre-pandemic (January 2017 to March 2020) and pandemic (March 2020 to March 2021) periods, we compared tracheal intubation opportunities by laryngoscopist level of training and specialty. We also compared first-attempt success and adverse airway outcomes between the two periods.

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Airway management in the pediatric emergency department in Japan: A multicenter prospective observational study

Hagiwara

Goto

Ohnishi

et al. 2022

Acute Medicine & Surgery

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Aim Tracheal intubation is a vital resuscitation procedure in the pediatric emergency department (ED). Despite its importance, little is known about the current status of emergency airway management in Japan. In this context, we aimed to investigate the airway management characteristics—particularly the location, patient, and provider factors—in the pediatric ED. Methods We conducted a multicenter, prospective study of five pediatric EDs in Japan from October 2018 to June 2020. The study included all children (aged ≤18 years) who underwent intubation at the pre‐ED or ED setting by physicians and those who were transferred from the ED to the operation room (OR) or pediatric intensive care unit (PICU) for intubation. We described the airway management characteristics according to the location, patient, and provider factors. Results Of 231 children, 9 (4%) were transferred to the OR or PICU for airway management. Among the remaining 222 children, 45 were intubated at the pre‐ED setting and 177 were intubated in the ED. The overall first‐attempt success rate was 72%, with the rate varying by location, patient, and provider factors—for example, 68% at the pre‐ED setting, 67% for children <2 years, 56% for children with airway‐related anatomical anomalies, and 61% with intubation by a resident physician. Intubation‐related adverse events were observed in 17%, most of which were hypoxemia (14%). Conclusions Based on data from a multicenter prospective study, the overall first‐attempt intubation success rate in pediatric EDs in Japan was 72%, with large variations by location, patient, and provider factors.

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Intubation practice and outcomes among pediatric emergency departments: A report from National Emergency Airway Registry for Children (NEAR4KIDS)

Cited by 19 publications

References 29 publications

The adjuncts for endotracheal tube passage in simulated pediatric airways (AET‐SPA) study

The adjuncts for endotracheal tube passage in simulated pediatric airways (AET‐SPA) study

See one, see one, teach one – Decisions on allocating intubation opportunities in pediatric emergency medicine

Airway management in the pediatric emergency department in Japan: A multicenter prospective observational study

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