Pediatric Intubation by Paramedics in a Large Emergency Medical Services System: Process, Challenges, and Outcomes

Prekker, Matthew E.; Delgado, Fernanda; Shin, Jenny; Kwok, Heemun; Johnson, Nicholas J.; Carlbom, David; Grabinsky, Andreas; Brogan, Thomas V.; King, Mary A.; Rea, Thomas D.

doi:10.1016/j.annemergmed.2015.07.021

Cited by 34 publications

(33 citation statements)

References 22 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…To the Editor: Our colleagues in King County recently reported on their experience with pediatric intubation (patients <13 years) by paramedics, including use of rapid sequence intubation. 1 This is in stark contrast to practice patterns in our own regions, where pediatric intubation in general (or pediatric rapid sequence intubation in North Carolina) is not part of the current emergency medical services (EMS) scopes of practice. In accordance with the available literature, including a large, randomized, controlled, out-of-hospital trial, 2 we believe the burden of proof for the EMS medical director should be to demonstrate above-average intubation performance and outcomes.…”

Section: Safety Of Pediatric Out-of-hospital Rapid Sequence Intubatiomentioning

confidence: 84%

“…The 66% first-pass success rate (75% with rapid sequence intubation) from the current experience compares favorably with published first-pass success in the pediatric emergency department (52% to 71%) and the pediatric ICU (62%). [1][2][3] Thus, the informed approach would proceed with intubation in the out-of-hospital setting rather than delay definitive airway care for upwards of 30 minutes, given our system's geospatial distribution.…”

Section: In Replymentioning

confidence: 99%

See 1 more Smart Citation

Safety of Pediatric Out-of-Hospital Rapid Sequence Intubation Not Demonstrated

Braude

Gausche‐Hill

Moore

et al. 2016

Annals of Emergency Medicine

View full text Add to dashboard Cite

Annals welcomes letters to the editor, including observations, opinions, corrections, very brief reports, and comments on published articles. Letters to the editor should not exceed 500 words and 5 references. They should be submitted using Annals' Web-based peer review system, Editorial Manager TM (http://www.editorialmanager.com/annemergmed). Annals no longer accepts submissions by mail. Letters should not contain abbreviations. Financial association or other possible conflicts of interest should always be disclosed, and their presence or absence will be published with the correspondence. Letters discussing an Annals article must be received within 8 weeks of the article's publication.

show abstract

Section: Safety Of Pediatric Out-of-hospital Rapid Sequence Intubatiomentioning

confidence: 84%

Section: In Replymentioning

confidence: 99%

Safety of Pediatric Out-of-Hospital Rapid Sequence Intubation Not Demonstrated

Braude

Gausche‐Hill

Moore

et al. 2016

Annals of Emergency Medicine

View full text Add to dashboard Cite

show abstract

“…39 We focused on TIs performed in the tertiary hospital setting, and these findings cannot be extrapolated to early TI by other providers including emergency medical service providers, where other challenges may be met. 15 We also recognize that the findings of a single-center with a limited PICU population would require validation from larger, multicentre studies or registries. Given the wide confidence intervals in our limited sample size, large studies are required to confirm the lack of association between the timing of TI and mortality.…”

Section: Discussionmentioning

confidence: 99%

“…[11][12][13][14] In settings where paramedics are trained to perform prehospital TI, challenges and complications have also been reported. 15,16 Adverse TI associated events and oxygen desaturations are associated with prolonged MV, while severe adverse events are associated with greater mortality in the pediatric intensive care unit (PICU). 17 In fact, critically ill patients are at greater risk for these adverse events compared to relatively well patients who undergo elective TI.…”

mentioning

confidence: 99%

Timing of tracheal intubation on mortality and duration of mechanical ventilation in critically ill children: A propensity score analysis

Chong

Dang

Loh

et al. 2020

Pediatric Pulmonology

View full text Add to dashboard Cite

Objective: We aimed to investigate whether early tracheal intubation (TI) is associated with a reduced risk of mortality and increased ventilator-free days (VFD). Methods: We performed a retrospective cohort study of children 0 to 18 years old in a pediatric intensive care unit (PICU), between 2008 and 2017. Patient demographics, vital signs, and laboratory findings were extracted. Using a time-dependent propensity score-matched algorithm, each patient was matched with another equally likely to be intubated within the same hour but was actually intubated with ≤2 hours, 2 to 4 hours, and 4 to 6 hours delays. Outcomes were mortality and VFD. Results: Among 333 patients, the median age was 1.72 years (interquartile range [IQR] 0.17-7.75). Thirty children died (9.0%) and the median PICU length of stay was 6.7 days (IQR 3.9-13.2). Early TI did not decrease mortality significantly when compared to a ≤2 hour delay (odds ratios [OR] 0.86; 95% CI, 0.40-1.85), a 2 to 4 hour delay (OR, 0.81; 95% CI, 0.39-1.69), or a 4 to 6 hour delay (OR, 0.87; 95% CI, 0.43-1.79). Similarly, early TI did not significantly increase VFD. Patients with early TI had 0.09 more VFD (95% CI −1.83 to 2.01) when compared to a delay within 2 hours, 0.23 more VFD (95% CI −1.66 to 2.13) when compared to a 2 to 4-hour delay and 0.56 more VFD (95% CI −1.49-2.61) when compared to a 4 to 6-hour delay. Conclusions: We did not find a significant association between the timing of TI and mortality or VFD in critically ill children.

show abstract

“…Emergency physicians have the advantage of concentrating these relatively rare procedures among a smaller group of providers compared to many EMS systems. In some EMS systems paramedics intubate a child once every 5–10 years, while in other systems where critical procedures are concentrated among a smaller group of providers, pediatric intubations happen once every 2–3 years for an individual medic 1,2. Increased exposure to these critical procedures in practice likely enhances skill retention and promotes safety and efficacy 3…”

Section: Introductionmentioning

confidence: 99%

Geospatial Analysis of Pediatric EMS Run Density and Endotracheal Intubation

Hansen¹,

Loker²,

Warden³

2016

WestJEM

View full text Add to dashboard Cite

IntroductionThe association between geographic factors, including transport distance, and pediatric emergency medical services (EMS) run clustering on out-of-hospital pediatric endotracheal intubation is unclear. The objective of this study was to determine if endotracheal intubation procedures are more likely to occur at greater distances from the hospital and near clusters of pediatric calls.MethodsThis was a retrospective observational study including all EMS runs for patients less than 18 years of age from 2008 to 2014 in a geographically large and diverse Oregon county that includes densely populated urban areas near Portland and remote rural areas. We geocoded scene addresses using the automated address locator created in the cloud-based mapping platform ArcGIS, supplemented with manual address geocoding for remaining cases. We then use the Getis-Ord Gi spatial statistic feature in ArcGIS to map statistically significant spatial clusters (hot spots) of pediatric EMS runs throughout the county. We then superimposed all intubation procedures performed during the study period on maps of pediatric EMS-run hot spots, pediatric population density, fire stations, and hospitals. We also performed multivariable logistic regression to determine if distance traveled to the hospital was associated with intubation after controlling for several confounding variables.ResultsWe identified a total of 7,797 pediatric EMS runs during the study period and 38 endotracheal intubations. In univariate analysis we found that patients who were intubated were similar to those who were not in gender and whether or not they were transported to a children’s hospital. Intubated patients tended to be transported shorter distances and were older than non-intubated patients. Increased distance from the hospital was associated with reduced odds of intubation after controlling for age, sex, scene location, and trauma system entry status in a multivariate logistic regression. The locations of intubations were superimposed on hot spots of all pediatric EMS runs. This map demonstrates that most of the intubations occurred within areas where pediatric EMS calls were highly clustered. By mapping the intubation procedures and pediatric population density, we found that intubation procedures were not clustered in a similar distribution to the pediatric population in the county.ConclusionIn this geographically diverse county the location of intubation procedures was similar to the clustering of pediatric EMS calls, and increased distance from the hospital was associated with reduced odds of intubation after controlling for several potential confounding variables.

show abstract

Pediatric Intubation by Paramedics in a Large Emergency Medical Services System: Process, Challenges, and Outcomes

Cited by 34 publications

References 22 publications

Safety of Pediatric Out-of-Hospital Rapid Sequence Intubation Not Demonstrated

Safety of Pediatric Out-of-Hospital Rapid Sequence Intubation Not Demonstrated

Timing of tracheal intubation on mortality and duration of mechanical ventilation in critically ill children: A propensity score analysis

Geospatial Analysis of Pediatric EMS Run Density and Endotracheal Intubation

Contact Info

Product

Resources

About