Clinical PaperThe factors associated with successful paediatric endotracheal intubation on the first attempt in emergency departments: A 13-emergency-department registry study☆
Section snippets
Study design
This study was a prospective observational study using data from a multicentre airway registry. The registry was formed from a network of 13 academic EDs. The data used for this study were collected from April 2006 to December 2010. All of the EDs employ full-time emergency medicine (EM) physicians and run 4-year EM residency training programs. In every ED, ETIs are performed both by EM physicians (residents and specialists) and physicians from other specialties (residents only) who are
Patient demographic data, indications for ETI and number of ETI attempts until success
A total of 10,942 ED patients were admitted during the study, and 281 (2.6%) of these patients were paediatric patients. Of the paediatric subjects, 170 were males, and 111 were females (Table 1). The median age of the 281 children studied was 23.8 months (IQR: 4.8–75.6 months): 50.2% were younger than 2 years and showed the largest anatomical–physiological differences from the adults; 13.5% were 8 years or older and were the most anatomically–physiologically similar to the adults; and 36.3%
Discussion
To date, most studies of paediatric airway management have been conducted with infants in the operating room or intensive care unit (ICU), and research on ETIs in paediatric ED patients has been scarce.7, 8, 9, 10, 11 Research is probably scarce because the rate of attempting intubation in paediatric ED patients is relatively low compared to that for the operating room or ICU.12 In this study, a total of 10,978 patients were enrolled in the registry, but only 281 (2.56%) of them were paediatric
Conclusions
The intubator's specialty was the major factor associated with FPS in emergency department paediatric ETI, The overall ETI FPS rate among paediatric patients was 67.6%, but the EM physicians had a FPS rate of 74.4%. A well-structured airway skill training program and more actively using the RSI method are important and this could explain this differences.
Competing interest
None.
Acknowledgments
We thank the effort and work of the Korean Emergency Airway Management Registry Investigators responsible for the input of the data: Young Min Kim, Young Soon Cho, Han Jin Cho, Young Min Oh, Hyunggoo Kang, Goo Hyun Kang, Hyung Min Lee, Jun Seok Park, and Soo Jin Kim. We also thank deeply the specialists of the emergency medicine of each hospital who made efforts to the registry input while treating emergency patients diligently.
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2017, Annals of Emergency MedicineCitation Excerpt :A German out-of-hospital study found an 85% (44/52) first-attempt success rate of pediatric oral out-of-hospital intubation with physician operators.5 Inhospital, 4 separate studies with physician operators found first-attempt success rates of 51.7% (59/114), 60.3% (763/1,265), 67.6% (190/281), and 81% (80/99).20,46,47,50 A pediatric ICU study with mostly physician operators and some nurse or respiratory therapist operators reported a first-attempt success rate of 62% (1,067/1,715).53
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A Spanish translated version of the abstract of this article appears as Appendix in the final online version at doi:10.1016/j.resuscitation.2012.03.010.