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How Often Does EMS Perform Pediatric Airway Management?

May 19, 2022

Written by Andy Hogan

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One in 180 out-of-hospital pediatric encounters require bag-mask ventilation (BMV) or advanced airway management (AAM). Of these, 49% involve tracheal intubation (TI) despite a lack of evidence showing superiority to BMV.

Why does this matter?
The ideal strategy for out-of-hospital pediatric airway management remains unclear despite recent developments in our understanding among adults. Characterizing the current epidemiology of pediatric airway interventions will help design research to answer this question.

Kids (airways) these days…
This descriptive analysis examined all pediatric patient care episodes from the 2019 NEMSIS data set to determine the frequency of airway management. ‘Airway interventions’ are described in the figure below.

Excerpted from Figure 1 (Hanlin ER, et al.)

Notable findings include:

  • Airway interventions occurred in 1 of 51 encounters (22,637/1,148,943).
  • BMV or AAM occurred in 1 of 180 encounters (6,395/1,148,943).
  • 49% of cases requiring BMV or AAM involved TI.
  • The success rate of TI was 75.2%.
  • Use of extraglottic airways (EGA) in pediatric patients increased from 1% in 2012 to 10% in 2019.
  • The success rate of EGA placement was 88%.
  • The laryngeal mask airway (LMA) was the most frequently used EGA.
  • The most reported complications were vomiting (1.0%) and bleeding (0.7%). Hypotension (0.01%) was rare.

BMV or AAM during pediatric EMS runs is infrequent (0.6%). The success rate of pediatric TI was higher than that reported in adults (52%), but a failure rate of 1 in 4 is high for an intervention without proven superiority to BMV. Furthermore, NEMSIS relies on the proceduralist to define success and doesn’t distinguish flawless first-pass intubations from those involving multiple attempts or adverse events. Opponents of intubation by paramedics could use these findings to reinforce their arguments. Nevertheless, these data pave the way for more rigorous head-to-head investigation of pediatric prehospital airway interventions.

Epidemiology of out-of-hospital pediatric airway management in the 2019 national emergency medical services information system data set. Resuscitation. 2022 Apr;173:124-133. doi: 10.1016/j.resuscitation.2022.01.008. Epub 2022 Jan 19.

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