How Children Are Intubated in Emergency Departments, 2002-2012
Daniel M. Lindbert, MD
National Emergency Airway Registry data show use of video laryngoscopy has increased and pretreatment has decreased..
Researchers analyzed data from the National Emergency Airway Registry (NEAR) for 1053 pediatric intubations (median age, 7 years) performed in 10 emergency departments from 2002 to 2012. They report first-pass success rates in relation to the indication for intubation and the use of paralytics, induction agents, and video laryngoscopy.
Trauma was the indication for half of intubations; seizure, overdose, and cardiac arrest were among the other indications. Trainees were the first to attempt intubation in 83% of cases. There were no surgical airways; first-pass success was recorded as 83% (ultimate success was 99.5%). In multivariable analysis, first-pass success was less likely in girls than in boys, in infants than in older children, and with direct laryngoscopy than with video laryngoscopy.
During the study period, use of pretreatment agents such as atropine and lidocaine and of prefasciculation declined substantially. Use of rocuronium increased to nearly that of succinylcholine, while etomidate remained the predominant induction agent throughout the study period. Use of video laryngoscopy increased (from 0% to nearly 50%), as it has in adult intubations (NEJM JW Emerg Med Mar 2015 and Ann Emerg Med 2014; [e-pub]).
For general emergency physicians, intubating a child can be a low-frequency, high-stress event. As the authors note, these observational data don’t prove that any particular practice results in greater first-pass success, but the high success rate at these centers can’t be ignored. Use video laryngoscopy, etomidate, and rapid-sequence intubation for most pediatric intubations.
Pallin DJ et al. Techniques and trends, success rates, and adverse events in emergency department pediatric intubations: A report from the National Emergency Airway Registry. Ann Emerg Med 2016 Feb 25; [e-pub].
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