title: Anaesthetist-provided pre-hospital advanced airway management in children: a descriptive study.
abstract: BACKGROUND
  Pre-hospital advanced airway management has been named one of the top-five research priorities in physician-provided pre-hospital critical care. Few studies have been made on paediatric pre-hospital advanced airway management. The aim of this study was to investigate pre-hospital endotracheal intubation success rate in children, first-pass success rates and complications related to pre-hospital advanced airway management in patients younger than 16 years of age treated by pre-hospital critical care teams in the Central Denmark Region (1.3 million inhabitants).
  
  
  METHODS
  A prospective descriptive study based on data collected from eight anaesthetist-staffed pre-hospital critical care teams between February 1st 2011 and November 1st 2012. Primary endpoints were 1) pre-hospital endotracheal intubation success rate in children 2) pre-hospital endotracheal intubation first-pass success rate in children and 3) complications related to prehospital advanced airway management in children.
  
  
  RESULTS
  The pre-hospital critical care anaesthetists attempted endotracheal intubation in 25 children, 13 of which were less than 2 years old. In one patient, a neonate (600 g birth weight), endotracheal intubation failed. The patient was managed by uneventful bag-mask ventilation. All other 24 children had their tracheas successfully intubated by the pre-hospital critical care anaesthetists resulting in a pre-hospital endotracheal intubation success rate of 96 %. Overall first pass success-rate was 75 %. In the group of patients younger than 2 years old, first pass success-rate was 54 %. The total rate of airway management related complications such as vomiting, aspiration, accidental intubation of the oesophagus or right main stem bronchus, hypoxia (oxygen saturation < 90 %) or bradycardia (according to age) was 20 % in children younger than 16 years of age and 38 % in children younger than 2 years of age. No deaths, cardiac arrests or severe bradycardia (heart rate <60) occurred in relation to pre-hospital advanced airway management.
  
  
  CONCLUSIONS
  Compared with the total population of patients receiving pre-hospital advanced airway management in our system, the overall success rate following pre-hospital endotracheal intubations in children is acceptable but the first-pass success rate is low. The complication rates in the paediatric population are higher than in our pre-hospital advanced airway management patient population as a whole. This illustrates that young children may represent a substantial pre-hospital airway management challenge even for experienced pre-hospital critical care anaesthetists. This may influence future training and quality insurance initiatives in paediatric pre-hospital advanced airway management.
authors: Pre-hospital Critical Care Team, Aarhus University Hospital, Oluf Palmes Alle 32, Aarhus N, 8200, Denmark. montar@rm.dk.|Department of Pre-hospital Medical Services, Central Denmark Region, Oluf Palmes Alle 34, Aarhus N, 8200, Denmark. montar@rm.dk.
authors: Mona
authors: M
authors: Tarpgaard
authors: Pre-hospital Critical Care Team, Aarhus University Hospital, Oluf Palmes Alle 32, Aarhus N, 8200, Denmark. troehans@rm.dk.|Department of Pre-hospital Medical Services, Central Denmark Region, Oluf Palmes Alle 34, Aarhus N, 8200, Denmark. troehans@rm.dk.
authors: Troels Martin
authors: TM
authors: Hansen
authors: Pre-hospital Critical Care Team, Aarhus University Hospital, Oluf Palmes Alle 32, Aarhus N, 8200, Denmark. leifrogn@rm.dk.|Department of Pre-hospital Medical Services, Central Denmark Region, Oluf Palmes Alle 34, Aarhus N, 8200, Denmark. leifrogn@rm.dk.
authors: Leif
authors: L
authors: Rognås
mesh_terms: D000293:Adolescent; D000367:Age Factors; D058109:Airway Management / Q000379:methods*; D000776:Anesthesiology; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D016208:Databases, Factual; D003718:Denmark; D004632:Emergency Medical Services / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D007442:Intubation, Intratracheal; D008297:Male; D009719:Nurse Anesthetists; D011446:Prospective Studies; D011787:Quality of Health Care; D012121:Respiration, Artificial / Q000009:adverse effects / Q000379:methods; D012131:Respiratory Insufficiency / Q000175:diagnosis / Q000628:therapy*; D018570:Risk Assessment; D015996:Survival Rate; D016896:Treatment Outcome