title: Two hundred sixty pediatric emergency airway encounters by air transport personnel: a report of the air transport emergency airway management (NEAR VI: "A-TEAM") project.
abstract: BACKGROUND
  Effective airway management is the cornerstone of resuscitative efforts for any critically ill or injured patient. The role and safety of pediatric prehospital intubation is controversial, particularly after prior research has shown varying degrees of intubation success. We report a series of consecutive prehospital pediatric intubations performed by air-transport providers.
  
  
  METHODS
  We retrospectively reviewed intubation flight records from an 89-rotorcraft, multistate emergency flight service during the time period from January 1, 2007, to December 31, 2009. All patients younger than 15 years were included in our analysis. We characterized patient, flight, and operator demographics; intubation methods; success rates; rescue techniques; and adverse events with descriptive statistics. We report proportions with 95% confidence intervals and differences between groups with Fisher exact and χ tests; P < 0.05 was considered significant.
  
  
  RESULTS
  Two hundred sixty pediatric intubations were performed consisting of 88 medical (33.8%) and 172 trauma (66.2%) cases; 98.8% (n = 257) underwent an orotracheal intubation attempt as the first method. First-pass intubation success was 78.6% (n = 202), and intubation was ultimately successful in 95.7% (n = 246) of cases. Medical and trauma intubations had similar success rates (98% vs 95%, Fisher exact test P = 0.3412). There was no difference in intubation success between age groups (χ = 0.26, P = 0.88). Three patients were managed primarily with an extraglottic device. Rescue techniques were used in 11 encounters (4.2%), all of which were successful. Cricothyrotomy was performed twice, both successful.
  
  
  CONCLUSIONS
  Prehospital pediatric intubation performed by air-transport providers, using rapid sequence intubation protocols, is highly successful. This effect on patient outcome requires further study.
authors: From the *Department of Emergency Medicine, Brigham and Women's Hospital; †Harvard-Affiliated Emergency Medicine Residency;‡Department of Emergency Medicine, University of Massachusetts, Worcester; §Division of Emergency Medicine, Harvard Medical School, Boston, MA; and ∥Department of Emergency Medicine, University of Illinois, Peoria, IL.
authors: William Wallace
authors: WW
authors: Tollefsen
authors: Calvin A
authors: CA
authors: Brown
authors: Kelly L
authors: KL
authors: Cox
authors: Ron M
authors: RM
authors: Walls
mesh_terms: D000293:Adolescent; D000367:Age Factors; D017732:Air Ambulances / Q000706:statistics & numerical data*; D000488:Allied Health Personnel / Q000193:education / Q000706:statistics & numerical data; D002648:Child; D002675:Child, Preschool; D003413:Cricoid Cartilage; D016638:Critical Illness / Q000453:epidemiology; D004630:Emergencies / Q000453:epidemiology*; D004632:Emergency Medical Services / Q000379:methods / Q000706:statistics & numerical data*; D016529:Emergency Nursing / Q000193:education / Q000706:statistics & numerical data; D005260:Female; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D007442:Intubation, Intratracheal / Q000295:instrumentation / Q000379:methods / Q000706:statistics & numerical data*; D008297:Male; D011677:Punctures / Q000706:statistics & numerical data; D012189:Retrospective Studies; D012640:Seizures / Q000453:epidemiology; D016896:Treatment Outcome; D014481:United States; D014947:Wounds and Injuries / Q000453:epidemiology