Success rates of pediatric intubation by a non-physician-staffed critical care transport service.
OBJECTIVE
Previous researchers have found that institution of an endotracheal intubation (ETI) protocol into a large urban paramedic program resulted in low success rates and had no beneficial effects. The primary goal of the current study was to assess ETI success rates achieved by a small cadre of nonphysician critical care transport (CCT) providers. A secondary objective was to assess for association between ETI success and factors such as age group or ETI setting (eg, in-hospital, in-aircraft).


METHODS
This retrospective study analyzed transport records of consecutive pediatric patients (younger than 13 years) in whom ETI was attempted by a nurse/paramedic (RN/EMTP) CCT crew working under protocols which included neuromuscular blockade (NMB)-facilitated ETI. The CCT service performs scene and interfacility transports in helicopter, fixed-wing (airplane), and ground critical care vehicles; pediatric patients are transferred to 4 receiving tertiary care centers. Chi2 test, Fisher exact test, and logistic regression analysis (P = 0.05) examined ETI success rates and assessed for association between ETI success and various characteristics (eg, age group, ETI setting).


RESULTS
The CCT crew attempted ETI in 143 patients, with success in 136 cases (95.1%). There were no unrecognized esophageal intubations. ETI success was of similar likelihood across pediatric age groups (P = 0.19) and in different ETI settings (P = 0.57).


CONCLUSIONS
CCT crew airway management success was very high in all practice settings. These data support contentions that, with a high level of initial and ongoing training, nonphysician CCT crew can successfully manage pediatric airways in a variety of circumstances.
Harrison
Timothy H
TH
*Boston MedFlight Critical Care Transport Service, Boston, MA; †Department of Emergency Services, Massachusetts General Hospital and Harvard Medical School, Boston, MA; ‡Department of Surgery, Boston University Medical School, Boston, MA.
Thomas
Stephen H
SH
Wedel
Suzanne K
SK
D002648:Child; D002675:Child, Preschool; D003422:Critical Care; D004634:Emergency Medical Technicians; D006801:Humans; D007223:Infant; D007442:Intubation, Intratracheal; D016015:Logistic Models; D017063:Outcome Assessment, Health Care; D012189:Retrospective Studies; D014187:Transportation of Patients