title: Tracheal intubation during pediatric cardiopulmonary resuscitation: A videography-based assessment in an emergency department resuscitation room.
abstract: OBJECTIVE
  To describe procedural characteristics of tracheal intubation (TI) during cardiopulmonary resuscitation (CPR) in a pediatric emergency department, and to characterize interruptions in CPR associated with TI performance.
  
  
  METHODS
  Retrospective single center case series. Resuscitations in a pediatric ED are videorecorded for quality improvement. Children who underwent TI while receiving chest compressions were eligible for inclusion. Intubations done by methods other than direct laryngoscopy were excluded. Background data included patient age and training background of intubator. Data on intubation attempts (success, laryngoscopy time) and chest compressions (interruptions, duration of pauses) were collected.
  
  
  RESULTS
  Between December 2012 and February 2014, 32 patients had 59 TI attempts performed during CPR. Overall first attempt success at TI was 15/32 (47%); a median of 2 attempts were made per patient (range 1 to 4). Median laryngoscopy time was 47s (range 8-115s). 32/59 (54%) TI attempts had an associated interruption in CPR; the median interruption duration was 25s (range 3-64s). TI attempts without interruption in CPR were successful in 20/32 (63%) compared to 11/27 (41%) when CPR was paused (p=0.09). Laryngoscopy time was not significantly different between TI attempts with (47±21s) and without (47±26s; p=0.2) interruptions in compressions. 25/32 (78%) of pauses exceeded 10s in duration.
  
  
  CONCLUSIONS
  TI during pediatric CPR results in significant interruptions in chest compressions. Procedural outcomes were not significantly different between attempts with and without compressions paused. In children receiving CPR, TI should be performed without pausing chest compressions.
authors.affiliation: Division of Critical Care Medicine, Children's Hospital of Philadelphia, Philadelphia, PA, USA; Division of Emergency Medicine, Children's Hospital of Philadelphia, Philadelphia, PA, USA; Center for Simulation, Innovation, and Advanced Education, Children's Hospital of Philadelphia, Philadelphia, PA, USA. Electronic address: Donoghue@email.chop.edu.
authors.forename: Aaron
authors.initials: A
authors.lastname: Donoghue
authors.affiliation: Center for Simulation, Innovation, and Advanced Education, Children's Hospital of Philadelphia, Philadelphia, PA, USA.
authors.forename: Ting-Chang
authors.initials: TC
authors.lastname: Hsieh
authors.affiliation: Division of Critical Care Medicine, Children's Hospital of Philadelphia, Philadelphia, PA, USA; Center for Simulation, Innovation, and Advanced Education, Children's Hospital of Philadelphia, Philadelphia, PA, USA.
authors.forename: Akira
authors.initials: A
authors.lastname: Nishisaki
authors.affiliation: Division of Emergency Medicine, Children's Hospital of Philadelphia, Philadelphia, PA, USA.
authors.forename: Sage
authors.initials: S
authors.lastname: Myers
mesh_terms: D000293:Adolescent; D000328:Adult; D016887:Cardiopulmonary Resuscitation / Q000379:methods*; D002648:Child; D002675:Child, Preschool; D004636:Emergency Service, Hospital; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D007442:Intubation, Intratracheal / Q000379:methods*; D011785:Quality Assurance, Health Care / Q000379:methods*; D012189:Retrospective Studies; D014741:Video Recording; D055815:Young Adult
keywords: CPR; Pediatrics; Tracheal intubation