Impact of an Extraglottic Device on Pediatric Airway Management in an Urban Prehospital System
Introduction: Prehospital pediatric endotracheal intubation has lower first-pass success rates compared to adult intubations and in general may not offer a survival benefit. Increasingly, emergency medical services (EMS) systems are deploying prehospital extraglottic airways (EGA) for primary pediat...
| Main Authors: | , , , , , , |
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| Format: | Article |
| Language: | English |
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eScholarship Publishing, University of California
2019-10-01
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| Series: | Western Journal of Emergency Medicine |
| Online Access: | https://escholarship.org/uc/item/5x47d800 |
| _version_ | 1819229695542034432 |
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| author | Daniel G. Ostermayer Elizabeth A. Camp James R. Langabeer Charles A. Brown Juan Mondragon David E. Persse Manish I. Shah |
| author_facet | Daniel G. Ostermayer Elizabeth A. Camp James R. Langabeer Charles A. Brown Juan Mondragon David E. Persse Manish I. Shah |
| author_sort | Daniel G. Ostermayer |
| collection | DOAJ |
| description | Introduction: Prehospital pediatric endotracheal intubation has lower first-pass success rates compared to adult intubations and in general may not offer a survival benefit. Increasingly, emergency medical services (EMS) systems are deploying prehospital extraglottic airways (EGA) for primary pediatric airway management, yet little is known about their efficacy. We evaluated the impact of a pediatric prehospital airway management protocol change, inclusive of EGAs, on airway management and patient outcomes in children in cardiac arrest or respiratory failure. Methods: Using data from a large, metropolitan, fire-based EMS service, we performed an observational study of pediatric patients with respiratory failure or cardiac arrest who were transported by EMS before and after implementation of an evidence-based airway management protocol inclusive of the addition of the EGA. The primary outcome was change in frequency of intubation attempts when paired with an initial EGA. Secondary outcomes included EGA and intubation success rates and patient survival to hospitalization and discharge. Results: We included 265 patients age <16 years old, with 142 pre- and 123 post-protocol change. Patient demographics and event characteristics were similar between groups. Intubation attempts declined from 79.6% pre- to 44.7% (p<0.01) post-protocol change. In patients with an intubation attempt, overall intubation success declined from 81.4% to 63.6% (p<0.01). Post-protocol change, an EGA was attempted in 52.8% of patients with 95.4% success. Conclusion: Implementation of an evidenced-based airway management algorithm for pediatric patients, inclusive of an EGA device for all age groups, was associated with fewer prehospital intubations. Intubation success may be negatively impacted due to decreases in procedural frequency. |
| first_indexed | 2024-12-23T11:17:16Z |
| format | Article |
| id | doaj.art-73c33e3c563c4854859c0bd5802388ce |
| institution | Directory Open Access Journal |
| issn | 1936-9018 |
| language | English |
| last_indexed | 2024-12-23T11:17:16Z |
| publishDate | 2019-10-01 |
| publisher | eScholarship Publishing, University of California |
| record_format | Article |
| series | Western Journal of Emergency Medicine |
| spelling | doaj.art-73c33e3c563c4854859c0bd5802388ce2022-12-21T17:49:10ZengeScholarship Publishing, University of CaliforniaWestern Journal of Emergency Medicine1936-90182019-10-0120610.5811/westjem.2019.8.44464wjem-20-962Impact of an Extraglottic Device on Pediatric Airway Management in an Urban Prehospital SystemDaniel G. Ostermayer0Elizabeth A. Camp1James R. Langabeer2Charles A. Brown3Juan Mondragon4David E. Persse5Manish I. Shah6McGovern Medical School, University of Texas Health Sciences Center, Department of Emergency Medicine, Houston, TexasBaylor College of Medicine, Texas Children’s Hospital, Department of Pediatrics, Section of Emergency Medicine, Houston, TexasMcGovern Medical School, University of Texas Health Sciences Center, Department of Emergency Medicine, Houston, TexasUniversity of Michigan Medical School, Department of Emergency Medicine, Ann Arbor, MichiganBaylor College of Medicine, Texas Children’s Hospital, Department of Pediatrics, Section of Emergency Medicine, Houston, TexasHouston Fire Department, Houston, TexasBaylor College of Medicine, Texas Children’s Hospital, Department of Pediatrics, Section of Emergency Medicine, Houston, TexasIntroduction: Prehospital pediatric endotracheal intubation has lower first-pass success rates compared to adult intubations and in general may not offer a survival benefit. Increasingly, emergency medical services (EMS) systems are deploying prehospital extraglottic airways (EGA) for primary pediatric airway management, yet little is known about their efficacy. We evaluated the impact of a pediatric prehospital airway management protocol change, inclusive of EGAs, on airway management and patient outcomes in children in cardiac arrest or respiratory failure. Methods: Using data from a large, metropolitan, fire-based EMS service, we performed an observational study of pediatric patients with respiratory failure or cardiac arrest who were transported by EMS before and after implementation of an evidence-based airway management protocol inclusive of the addition of the EGA. The primary outcome was change in frequency of intubation attempts when paired with an initial EGA. Secondary outcomes included EGA and intubation success rates and patient survival to hospitalization and discharge. Results: We included 265 patients age <16 years old, with 142 pre- and 123 post-protocol change. Patient demographics and event characteristics were similar between groups. Intubation attempts declined from 79.6% pre- to 44.7% (p<0.01) post-protocol change. In patients with an intubation attempt, overall intubation success declined from 81.4% to 63.6% (p<0.01). Post-protocol change, an EGA was attempted in 52.8% of patients with 95.4% success. Conclusion: Implementation of an evidenced-based airway management algorithm for pediatric patients, inclusive of an EGA device for all age groups, was associated with fewer prehospital intubations. Intubation success may be negatively impacted due to decreases in procedural frequency.https://escholarship.org/uc/item/5x47d800 |
| spellingShingle | Daniel G. Ostermayer Elizabeth A. Camp James R. Langabeer Charles A. Brown Juan Mondragon David E. Persse Manish I. Shah Impact of an Extraglottic Device on Pediatric Airway Management in an Urban Prehospital System Western Journal of Emergency Medicine |
| title | Impact of an Extraglottic Device on Pediatric Airway Management in an Urban Prehospital System |
| title_full | Impact of an Extraglottic Device on Pediatric Airway Management in an Urban Prehospital System |
| title_fullStr | Impact of an Extraglottic Device on Pediatric Airway Management in an Urban Prehospital System |
| title_full_unstemmed | Impact of an Extraglottic Device on Pediatric Airway Management in an Urban Prehospital System |
| title_short | Impact of an Extraglottic Device on Pediatric Airway Management in an Urban Prehospital System |
| title_sort | impact of an extraglottic device on pediatric airway management in an urban prehospital system |
| url | https://escholarship.org/uc/item/5x47d800 |
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