title: Factors Associated with First-Pass Success in Pediatric Intubation in the Emergency Department.
abstract: BACKGROUND
  The objective of this study was to investigate the factors associated with first-pass success in pediatric intubation in the emergency department (ED).
  
  
  METHODS
  We analyzed the data from two multicenter prospective studies of ED intubation in 17 EDs between April 2010 and September 2014. The studies prospectively measured patient's age, sex, principal indication for intubation, methods (e.g., rapid sequence intubation [RSI]), devices, and intubator's level of training and specialty. To evaluate independent predictors of first-pass success, we fit logistic regression model with generalized estimating equations. In the sensitivity analysis, we repeated the analysis in children <10 years.
  
  
  RESULTS
  A total of 293 children aged ≤18 years who underwent ED intubation were eligible for the analysis. The overall first-pass success rate was 60% (95%CI [54%-66%]). In the multivariable model, age ≥10 years (adjusted odds ratio [aOR], 2.45; 95% CI [1.23-4.87]), use of RSI (aOR, 2.17; 95% CI [1.31-3.57]), and intubation attempt by an emergency physician (aOR, 3.21; 95% CI [1.78-5.83]) were significantly associated with a higher chance of first-pass success. Likewise, in the sensitivity analysis, the use of RSI (aOR, 3.05; 95% CI [1.63-5.70]), and intubation attempt by an emergency physician (aOR, 4.08; 95% CI [1.92-8.63]) were significantly associated with a higher chance of first-pass success.
  
  
  CONCLUSIONS
  Based on two large multicenter prospective studies of ED airway management, we found that older age, use of RSI, and intubation by emergency physicians were the independent predictors of a higher chance of first-pass success in children. Our findings should facilitate investigations to develop optimal airway management strategies in critically-ill children in the ED.
authors.affiliation: Massachusetts General Hospital, Department of Emergency Medicine, Boston, Massachusetts.
authors.forename: Tadahiro
authors.initials: T
authors.lastname: Goto
authors.affiliation: Okinawa Prefectural Chubu Hospital, Department of Emergency Medicine, Okinawa, Japan.
authors.forename: Koichiro
authors.initials: K
authors.lastname: Gibo
authors.affiliation: Tokyo Metropolitan Children's Medical Center, Division of Paediatric Emergency Medicine, Department of Paediatric Emergency and Critical Care Medicine, Tokyo, Japan.
authors.forename: Yusuke
authors.initials: Y
authors.lastname: Hagiwara
authors.affiliation: Mayo Clinic, Department of Emergency Medicine, Rochester, Minnesota.
authors.forename: Masashi
authors.initials: M
authors.lastname: Okubo
authors.affiliation: Massachusetts General Hospital, Department of Emergency Medicine, Boston, Massachusetts.
authors.forename: David F M
authors.initials: DF
authors.lastname: Brown
authors.affiliation: Brigham and Women's Hospital, Department of Emergency Medicine, Boston, Massachusetts.
authors.forename: Calvin A
authors.initials: CA
authors.lastname: Brown
authors.affiliation: Massachusetts General Hospital, Department of Emergency Medicine, Boston, Massachusetts.
authors.forename: Kohei
authors.initials: K
authors.lastname: Hasegawa
mesh_terms: D000293:Adolescent; D058109:Airway Management / Q000379:methods*; D002648:Child; D002675:Child, Preschool; D002983:Clinical Competence; D004636:Emergency Service, Hospital; D004638:Emergency Treatment; D005260:Female; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D007442:Intubation, Intratracheal; D016015:Logistic Models; D008297:Male; D015999:Multivariate Analysis; D000070316:Pediatric Emergency Medicine; D011446:Prospective Studies; D014481:United States