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Failure on Peds First-Pass ETT and Risk of Arrest

January 3, 2018

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In pediatric patients with respiratory distress, failure of intubation on the first attempt was associated with increased risk of arrest.

Why does this matter?
We know first-pass endotracheal tube success is important.  The incidence of adverse events skyrockets after one failed attempt.  See this study and blog on Resus.me.  The current study increases this concern even more.

No pressure – but if you fail, they arrest.
There were 2,210 pediatric respiratory compromise events in this AHA registry; 34% did not need an invasive airway.  54% had success of ETT placement on the first try.  Of the 12% who did not have success of airway placement on the first attempt, the adjusted odds of progression to cardiac arrest, compared to the group with first-pass success, went up 80%, (adjusted odds ratio 1.8 [95% CIs, 1.2-2.6]).  The implication for teaching facilities is to carefully select which patients are chosen for intubation by novice operators.  The sickest children with respiratory distress may not be the best to learn on.  The other practical take-home is to prepare in advance, optimize oxygenation, and have supplies and adjuncts at hand prior to induction.

Failure of Invasive Airway Placement on the First Attempt Is Associated With Progression to Cardiac Arrest in Pediatric Acute Respiratory Compromise.  Pediatr Crit Care Med. 2017 Nov 10. doi: 10.1097/PCC.0000000000001370. [Epub ahead of print]

Peer reviewed by Thomas Davis, MD.

What are your thoughts?