Our study, “Practice Patterns and Performance of Pediatric Air Medical Tracheal Intubation: A National Multisite Cohort Study,” was published in Prehospital Emergency Care.
Primary Author: Jeffrey Cloyd, MD, Assistant Professor of Emergency Medicine, University of Tennessee Medical Center Knoxville
Primary Question Answered: What are the characteristics and immediate outcomes of pediatric patients being transported by air medical services?
High Level Answer: In this national cohort of air medical services, airway performance was favorable but signals of concern were found among infants showing lower first-pass and overall intubation success, and less frequent post-intubation ETCO₂ documentation.
Intubating pediatric patients is a low-frequency but high-acuity clinical skill. Air medical clinicians have additional training as well as a higher scope of care than traditional out-of-hospital clinicians, but our evidence-base for pediatric intubation among these clinicians is thin. To help fill this gap and inform evidence-based care for these critical patients, we examined air medical service intubation of pediatric patients among 4 years of ImageTrend Collaborate Data.
We included over 1,000 EMS encounters for evaluation. The median age of the sample was 13, with over half suffering trauma or burn injuries. Ketamine was the most common induction agent, a sedative-plus paralytic strategy was used over 75% of the time, and video laryngoscopy was documented less than 10% of the time. First pass success was over 85% and overall success was over 90%. Infants under 1 year old had a lower first pass success (69%) and overall success (81%).
With this work, we’ve provided recent, real-world evidence surrounding the care of our sickest children. Our future steps in this area include dedicated evaluation of differences in success and outcomes for infants, as well as continued overall work to inform the conversation around high-acuity and low-frequency critical skills.
What This Means for Your Agency
Two things:
- These data show us that pediatric intubation is absolutely a low-frequency and high acuity skill. Even among air medical out-of-hospital clinicians, who receive additional training and have an expanded scope of practice, we still see gaps that can be addressed to improve patient outcomes. These findings have an impact on current training paradigms as well as raising the question for the presence of or magnitude of this gap among traditional out-of-hospital clinicians.
- Your data are being put to good use! Pediatric intubation is a low-frequency event for individual agencies, so a national dataset helps researchers identify patterns that may be difficult to see locally.
Agencies can opt in to ImageTrend Collaborate at no cost. The data are de-identified and can help inform agency and clinician decision-making.
