Out-of-hospital pediatric airway management in the United States.
OBJECTIVE
The objective of this study was to characterize pediatric out-of-hospital airway management interventions, success rates, and complications in the United States using the 2012 National Emergency Medical Services Information System (NEMSIS) dataset.


METHODS
In 2012, NEMSIS collected data from Emergency Medical Services (EMS) encounters in 40 states. We included all patients less than 18 years of age and identified all patients who had airway interventions including endotracheal intubation (ETI), bag-valve-mask ventilation (BVM), continuous positive airway pressure/bilevel positive airway pressure (CPAP/BiPAP) and alternate airways (Combitube, King LT, Laryngeal Mask Airway (LMA), esophageal obturator airway, and cricothyroidotomy). Success and complication rates were analyzed and compared across pediatric age groups, by race, ethnicity, clinical condition, and geographic region.


RESULTS
We identified a total of 949,301 pediatric patient care events in the NEMSIS 2012 dataset. 4.5% had airway management procedures (42,936 events). Invasive airway management or ventilation (ETI, cricothyroidotomy, alternate airway, CPAP/BiPAP, BVM and other ventilation) took place in 1.5% of patient care events (14,107). Of those who had invasive airway management, 29.9% were less than 1 year of age, 58.1% were male, 42.3% were white, and 83.6% were in urban areas. ETI occurred in 3124 of patient care events (329 per 100,000; 95% CI 318-341). Overall success of ETI was 81.1% (95% CI 79.7-82.6). Lower success was noted in patients with cardiac arrest (75.5%, 95% CI 72.6-78.3) and those aged 1-12 months (72.1%, 95% CI 68.3-75.6).


CONCLUSIONS
Out-of-hospital pediatric advanced airway procedures were infrequently performed. Success rates are lowest in patients aged 1-12 months.
Department of Emergency Medicine, Oregon Health & Science University, United States. Electronic address: hansemat@ohsu.edu.
Matthew
M
Hansen
Department of Public Health & Preventive Medicine, Oregon Health & Science University, United States.
William
W
Lambert
Department of Emergency Medicine, Oregon Health & Science University, United States; Department of Public Health & Preventive Medicine, Oregon Health & Science University, United States; Department of Obstetrics & Gynecology, Oregon Health & Science University, United States.
Jeanne-Marie
JM
Guise
Department of Emergency Medicine, Oregon Health & Science University, United States.
Craig R
CR
Warden
Department of Pediatrics, University of Utah School of Medicine, United States.
N Clay
NC
Mann
Department of Emergency Medicine, University of Alabama Birmingham, United States.
Henry
H
Wang
D000293:Adolescent; D000367:Age Factors; D058109:Airway Management / Q000706:statistics & numerical data*; D019296:Capnography / Q000706:statistics & numerical data; D002648:Child; D002675:Child, Preschool; D003124:Colorimetry / Q000295:instrumentation / Q000706:statistics & numerical data; D016208:Databases, Factual; D004632:Emergency Medical Services; D005260:Female; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D009330:Nebulizers and Vaporizers / Q000706:statistics & numerical data; D058687:Out-of-Hospital Cardiac Arrest / Q000628:therapy; D012111:Residence Characteristics; D014481:United States / Q000453:epidemiology
Intubation; Out-of-hospital airway management; Pediatric airway management; Pediatric out-of-hospital care; Pediatric prehospital care; Supraglottic device