Characteristics and outcome of prehospital paediatric tracheal intubation attended by anaesthesia-trained emergency physicians.
OBJECTIVE
To collect data regarding prehospital paediatric tracheal intubation by emergency physicians skilled in advanced airway management.


METHODS
A prospective 8-year observational study of a single emergency physician-staffed emergency medical service. Self-reporting by emergency physicians of all children aged 0-14 years who had prehospital tracheal intubation and were attended by either anaesthesia-trained emergency physicians (group 1) or by a mixture of anaesthesia and non-anaesthesia-trained emergency physicians (group 2).


RESULTS
Eighty-two out of 2040 children (4.0%) had prehospital tracheal intubation (58 in group 1). The most common diagnoses were trauma (50%; in school children, 73.0%), convulsions (13.4%) and SIDS (12.2%; in infants, 58.8%). The overall tracheal intubation success rate was 57 out of 58 attempts (98.3%). Compared to older children, infants had a higher number of Cormack-Lehane scores of 3 or 4, "difficult to intubate" status (both 3 out of 13; 23.1%) and a lower first attempt success rate for tracheal intubation (p=0.04). Among all 82 children 71 (86.6%) survived to hospital admission and 63 (76.8%) to discharge. Of the 63 survivors, 54 (85.7%) demonstrated a favourable or unchanged neurological outcome (PCPC 1-3). The survival and neurological outcomes of infants were inferior compared to older children (p<0.001). On average an emergency physician performed one prehospital tracheal intubation in 3 years in a child and one in 13 years in an infant.


CONCLUSIONS
Anaesthesia-trained emergency physicians working in our system report high success rates for prehospital tracheal intubation in children. Survival and neurological outcomes were considerably better than reported in previous studies.
Eich
Christoph
C
Department of Anaesthesiology, Emergency and Intensive Care Medicine, University Medical Centre, 37075 Göttingen, Germany. ceich@med.uni-goettingen.de
Roessler
Markus
M
Nemeth
Marcus
M
Russo
Sebastian G
SG
Heuer
Jan F
JF
Timmermann
Arnd
A
D000293:Adolescent; D000367:Age Factors; D000776:Anesthesiology / Q000193:education*; D002648:Child; D002675:Child, Preschool; D004632:Emergency Medical Services; D004635:Emergency Medicine / Q000193:education*; D004638:Emergency Treatment / Q000592:standards*; D005260:Female; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D007442:Intubation, Intratracheal; D008297:Male; D011446:Prospective Studies; D015996:Survival Rate; D016896:Treatment Outcome