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West J Emerg Med. 2016 Mar;17(2):129-34. doi: 10.5811/westjem.2016.1.28685. Epub 2016 Mar 2.

Factors Associated with First-Pass Success in Pediatric Intubation in the Emergency Department.

Author information

1
Massachusetts General Hospital, Department of Emergency Medicine, Boston, Massachusetts.
2
Okinawa Prefectural Chubu Hospital, Department of Emergency Medicine, Okinawa, Japan.
3
Tokyo Metropolitan Children's Medical Center, Division of Paediatric Emergency Medicine, Department of Paediatric Emergency and Critical Care Medicine, Tokyo, Japan.
4
Mayo Clinic, Department of Emergency Medicine, Rochester, Minnesota.
5
Brigham and Women's Hospital, Department of Emergency Medicine, Boston, Massachusetts.

Abstract

INTRODUCTION:

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.

CONCLUSION:

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.

PMID:
26973736
PMCID:
PMC4786230
DOI:
10.5811/westjem.2016.1.28685
[Indexed for MEDLINE]
Free PMC Article

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