title: Endotracheal intubation in the pediatric emergency department.
abstract: OBJECTIVE
  Prospective safety data on emergency department (ED) intubation in children are limited. We aimed to describe the practice and adverse events associated with endotracheal intubation in a large urban pediatric ED.
  
  
  METHODS
  Prospective observational study at a tertiary pediatric ED with an annual census of 82,000. The primary outcome measure was the adverse event rate. Secondary outcome measures were incidence of difficult laryngoscopy and first pass success rate without desaturation or hypotension.
  
  
  RESULTS
  Over a 12-month period in 2013, there were 71 intubations in 66 patients (9/10,000 ED visits). Median age was 3 years, with 25% in infants <1 year of age. Indications were as follows: trauma (21%) and medical conditions (79%); most frequently status epileptics (31%). Forty-four percent had cardiovascular compromise, 87% had respiratory compromise, and 70% had a GCS <9 prior to intubation. Adverse events occurred in 39%, the most common being hypotension (21%) and desaturation (14%). One anticipated and one unanticipated difficult laryngoscopy were encountered (both Cormack and Lehane grade 3). Overall first pass success rate was 78%, although first pass success without desaturation or hypotension was only 49%. Seven percent required more than two attempts for successful intubation.
  
  
  CONCLUSIONS
  Intubation of children in the ED is a low-frequency, high-risk procedure. The incidence of adverse events, particularly desaturation and hypotension, is high. The incidence of difficult laryngoscopy is low. First pass success rate without desaturation or hypotension is low. Strategies to avoid desaturation and hypotension in the peri-intubation setting should be prioritized.
authors.affiliation: Department of Emergency Medicine, Royal Children's Hospital, Parkville, Vic., Australia; Murdoch Children's Research Institute, Parkville, Vic., Australia; Department of Paediatrics, Faculty of Medicine, Dentistry, and Health Sciences, University of Melbourne, Melbourne, Vic., Australia.
authors.forename: Elliot
authors.initials: E
authors.lastname: Long
authors.forename: Stefan
authors.initials: S
authors.lastname: Sabato
authors.forename: Franz E
authors.initials: FE
authors.lastname: Babl
mesh_terms: D000777:Anesthetics; D002648:Child; D002675:Child, Preschool; D004632:Emergency Medical Services / Q000379:methods*; D004636:Emergency Service, Hospital; D005260:Female; D006801:Humans; D007223:Infant; D007442:Intubation, Intratracheal / Q000009:adverse effects / Q000379:methods*; D007828:Laryngoscopy / Q000706:statistics & numerical data; D008297:Male; D061214:Patient Safety; D011446:Prospective Studies; D062606:Tertiary Care Centers; D016896:Treatment Outcome
chemical_list: D000777:Anesthetics
keywords: adverse events; child; difficult laryngoscopy; emergency department; intubation