Hostname: page-component-76fb5796d-2lccl Total loading time: 0 Render date: 2024-04-27T09:28:54.374Z Has data issue: false hasContentIssue false
  • English
  • Français

Paramedics’ Success and Complications in Prehospital Pediatric Intubation: A Meta-Analysis

Published online by Cambridge University Press:  27 March 2024

Faisal A. AlGhamdi Open the ORCID record for Faisal A. AlGhamdi [Opens in a new window] ,
Nasser A. AlJoaib ,
Abdulaziz M. Saati ,
Mishal A. Abu Melha  and
Mohammad A. Alkhofi
Faisal A. AlGhamdi*
Affiliation:
College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
Nasser A. AlJoaib
Affiliation:
College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
Abdulaziz M. Saati
Affiliation:
College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
Mishal A. Abu Melha
Affiliation:
College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
Mohammad A. Alkhofi
Affiliation:
Department of Pediatrics, King Fahad University Hospital, Imam Abdulrahman bin Faisal’s University, Khobar, Saudi Arabia
*
Correspondence: Faisal A. AlGhamdi P.O. Box 2435, Dammam 31441 Kingdom of Saudi Arabia E-mail: Faisalgh218@gmail.com
Get access Rights & Permissions [Opens in a new window]

Abstract

Background:

Prehospital pediatric intubation is a potentially life-saving procedure in which paramedics are relied upon. However, due to the anatomical nature of pediatrics and associated adverse events, it is more challenging compared to adult intubation. In this study, the knowledge and attitude of paramedics was assessed by measuring their overall success rate and associated complications.

Methods:

An online search using PubMed, Scopus, Web of Science, and Cochrane CENTRAL was conducted using relevant keywords to include studies that assess success rates and associated complications. Studies for eligibility were screened. Data were extracted from eligible studies and pooled as risk ratio (RR) with a 95% confidence interval (CI).

Results:

Thirty-eight studies involving 14,207 pediatrics undergoing intubation by paramedics were included in this study. The prevalence of success rate was 82.5% (95% CI, 0.745-0.832) for overall trials and 77.2% (95% CI, 0.713-0.832) success rate after the first attempt. By subgrouping the patients according to using muscle relaxants during intubation, the group that used muscle relaxants showed a high overall successful rate of 92.5% (95% CI, 0.877-0.973) and 79.9% (95% CI, 0.715-0.994) success rate after the first attempt, more than the group without muscle relaxant which represent 78.9% (95% CI, 0.745-0.832) overall success rate and 73.3% (95% CI, 0.616-0.950) success rate after first attempt.

Conclusion:

Paramedics have a good overall successful rate of pediatric intubation with a lower complication rate, especially when using muscle relaxants.

Keywords

airway managementchildendotracheal intubationparamedicspediatrics
Type
Systematic Review
Information
Prehospital and Disaster Medicine , Volume 39 , Issue 2 , April 2024 , pp. 184 - 194
Check for updates
Copyright
© The Author(s), 2024. Published by Cambridge University Press on behalf of World Association for Disaster and Emergency Medicine

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Mehmood, A, Rowther, AA, Kobusingye, O, Hyder, AA. Assessment of pre-hospital emergency medical services in low-income settings using a health systems approach. Int J Emerg Med. 2018;11(1):53.CrossRefGoogle ScholarPubMed
Aziz, K, Lee, HC, Escobedo, MB, et al. Part 5: neonatal resuscitation: 2020 American Heart Association guidelines for cardiopulmonary resuscitation and emergency cardiovascular care. Circulation. 2020;142(16_suppl_2):S524–550.CrossRefGoogle ScholarPubMed
Vega, RM, Kaur, H, Sasaki, J, Edemekong, PF. Cardiopulmonary Arrest in Children. Treasure Island, Florida USA: StatPearls Publishing; 2023.Google ScholarPubMed
Okubo, M, Komukai, S, Izawa, J, et al. Prehospital advanced airway management for pediatric patients with out-of-hospital cardiac arrest: a nationwide cohort study. Resuscitation. 2019;145:175–184.CrossRefGoogle ScholarPubMed
Orso, D, Vetrugno, L, Federici, N, D’Andrea, N, Bove, T. Endotracheal intubation to reduce aspiration events in acutely comatose patients: a systematic review. Scand J Trauma Resusc Emerg Med. 2020;28(1):116.CrossRefGoogle ScholarPubMed
Crewdson, K, Lockey, D, Voelckel, W, Temesvari, P, Lossius, HM; Medical Working Group, EHAC. Best practice advice on pre-hospital emergency anesthesia & advanced airway management. Scand J Trauma Resusc Emerg Med. 2019;27(1):6.CrossRefGoogle ScholarPubMed
Delorenzo, A, St Clair, T, Andrew, E, Bernard, S, Smith, K. Prehospital rapid sequence intubation by intensive care flight paramedics. Prehosp Emerg Care. 2018;22(5):595–601.CrossRefGoogle ScholarPubMed
Soti, A, Temesvari, P, Hetzman, L, Eross, A, Petroczy, A. Implementing new advanced airway management standards in the Hungarian physician staffed Helicopter Emergency Medical Service. Scand J Trauma Resusc Emerg Med. 2015;23:3.CrossRefGoogle ScholarPubMed
Burns, B, Habig, K, Eason, H, Ware, S. Difficult intubation factors in prehospital rapid sequence intubation by an Australian helicopter emergency medical service. Air Med J. 2016;35(1):28–32.CrossRefGoogle ScholarPubMed
Harless, J, Ramaiah, R, Bhananker, SM. Pediatric airway management. Int J Crit Illn Inj Sci. 2014;4(1):65–70.Google ScholarPubMed
Meckler, G, Hansen, M, Lambert, W, et al. Out-of-hospital pediatric patient safety events: results of the CSI chart review. Prehosp Emerg Care. 2018;22(3):290–299.CrossRefGoogle ScholarPubMed
Garner, AA, Bennett, N, Weatherall, A, Lee, A. Physician-staffed helicopter emergency medical services augment ground ambulance pediatric airway management in urban areas: a retrospective cohort study. Emerg Med J. 2019;36(11):678–683.CrossRefGoogle ScholarPubMed
Zwingmann, J, Mehlhorn, AT, Hammer, T, Bayer, J, Südkamp, NP, Strohm, PC. Survival and neurologic outcome after traumatic out-of-hospital cardiopulmonary arrest in a pediatric and adult population: a systematic review. Crit Care. 2012;16(4):R117.CrossRefGoogle Scholar
Akbudak, IH, Mete, A. Pathophysiology of Apnea, Hypoxia, and Preoxygenation. In: Erbay, RH, (ed). Tracheal Intubation. London, UK: InTech; 2018.Google Scholar
Mahtani, KR, Eaton, G, Catterall, M, Ridley, A. Setting the scene for paramedics in general practice: what can we expect? J R Soc Med. 2018;111(6):195–198.CrossRefGoogle ScholarPubMed
Dowling, C. Factors affecting paramedic personnel in the assessment and management of emergency pediatric patients within the prehospital settings in the United Kingdom. Int J MCH AIDS. 2023;12(1):e600.CrossRefGoogle ScholarPubMed
Garner, AA, Bennett, N, Weatherall, A, Lee, A. Success and complications by team composition for prehospital pediatric intubation: a systematic review and meta-analysis. Crit Care. 2020;24(1):149.CrossRefGoogle ScholarPubMed
Hutton, B, Salanti, G, Caldwell, DM, et al. The PRISMA extension statement for reporting of systematic reviews incorporating network meta-analyses of health care interventions: checklist and explanations. Ann Intern Med. 2015;162(11):777–784.CrossRefGoogle ScholarPubMed
Cochrane Handbook for Systematic Reviews of Interventions. Cochrane Training. https://training.cochrane.org/handbook. Accessed October 15, 2023.Google Scholar
The Newcastle–Ottawa Scale (NOS) for Assessing the Quality of Non-Randomized Studies in Meta-Analysis. https://www.researchgate.net/publication/261773681_The_Newcastle-Ottawa_Scale_NOS_for_Assessing_the_Quality_of_Non-Randomized_Studies_in_Meta-Analysis. Accessed October 15, 2023.Google Scholar
Higgins, JPT, Altman, DG, Gøtzsche, PC, et al. The Cochrane Collaboration’s tool for assessing risk of bias in randomized trials. BMJ. 2011;343:d5928.CrossRefGoogle Scholar
Vilke, GM, Steen, PJ, Smith, AM, Chan, TC. Out-of-hospital pediatric intubation by paramedics: the San Diego experience. J Emerg Med. 2002;22(1):71–74.CrossRefGoogle ScholarPubMed
Tweed, J, George, T, Greenwell, C, Vinson, L. Prehospital airway management examined at two pediatric emergency centers. Prehosp Disaster Med. 2018;33(5):532–538.CrossRefGoogle ScholarPubMed
Tollefsen, WW, Brown, CA, Cox, KL, Walls, RM. Two hundred sixty pediatric emergency airway encounters by air transport personnel: a report of the air transport emergency airway management (NEAR VI: “A-TEAM”) project. Pediatr Emerg Care. 2013;29(9):963–968.CrossRefGoogle ScholarPubMed
Tham, LP, Fook-Chong, S, Binte Ahmad, NS, et al. Pre-hospital airway management and survival outcomes after pediatric out-of-hospital cardiac arrests. Resuscitation. 2022;176:9–18.CrossRefGoogle Scholar
Solan, T, Cudini, D, Humar, M, et al. Characteristics of pediatric pre-hospital intubation by intensive care paramedics. Emerg Med Australas. 2023;35(5):754–758.CrossRefGoogle ScholarPubMed
Sing, RF, Reilly, PM, Rotondo, MF, Lynch, MJ, McCans, JP, Schwab, CW. Out-of-hospital rapid-sequence induction for intubation of the pediatric patient. Acad Emerg Med. 1996;3(1):41–45.CrossRefGoogle ScholarPubMed
Ramgopal, S, Button, SE, Owusu-Ansah, S, et al. Success of pediatric intubations performed by a critical care transport service. Prehosp Emerg Care. 2020;24(5):683–692.CrossRefGoogle ScholarPubMed
Prekker, ME, Delgado, F, Shin, J, et al. Pediatric intubation by paramedics in a large emergency medical services system: process, challenges, and outcomes. Ann Emerg Med. 2016;67(1):20–29.CrossRefGoogle Scholar
Pointer, JE. Clinical characteristics of paramedics’ performance of pediatric endotracheal intubation. Am J Emerg Med. 1989;7(4):364–366.CrossRefGoogle ScholarPubMed
Nehme, Z, Namachivayam, S, Forrest, A, Butt, W, Bernard, S, Smith, K. Trends in the incidence and outcome of pediatric out-of-hospital cardiac arrest: a 17-year observational study. Resuscitation. 2018;128:43–50.CrossRefGoogle ScholarPubMed
Nakayama, DK, Gardner, MJ, Rowe, MI. Emergency endotracheal intubation in pediatric trauma. Ann Surg. 1990;211(2):218–223.CrossRefGoogle ScholarPubMed
Moors, XRJ, Rijs, K, Den Hartog, D, Stolker, RJ. Pediatric out-of-hospital cardiopulmonary resuscitation by helicopter emergency medical service, does it have added value compared to regular emergency medical service? Eur J Trauma Emerg Surg. 2018;44(3):407–410.CrossRefGoogle ScholarPubMed
Losek, JD, Szewczuga, D, Glaeser, PW. Improved prehospital pediatric ALS care after an EMT-paramedic clinical training course. Am J Emerg Med. 1994;12(4):429–432.CrossRefGoogle ScholarPubMed
Losek, JD, Bonadio, WA, Walsh-Kelly, C, Hennes, H, Smith, DS, Glaeser, PW. Prehospital pediatric endotracheal intubation performance review. Pediatr Emerg Care. 1989;5(1):1–4.CrossRefGoogle ScholarPubMed
Lavery, RF, Tortella, BJ, Griffin, CC. The prehospital treatment of pediatric trauma. Pediatr Emerg Care. 1992;8(1):9–12.CrossRefGoogle ScholarPubMed
Kumar, VR, Bachman, DT, Kiskaddon, RT. Children and adults in cardiopulmonary arrest: are advanced life support guidelines followed in the prehospital setting? Ann Emerg Med. 1997;29(6):743–747.CrossRefGoogle ScholarPubMed
Jarvis, JL, Wampler, D, Wang, HE. Association of patient age with first pass success in out-of-hospital advanced airway management. Resuscitation. 2019;141:136–143.CrossRefGoogle ScholarPubMed
Heschl, S, Meadley, B, Andrew, E, Butt, W, Bernard, S, Smith, K. Efficacy of pre-hospital rapid sequence intubation in pediatric traumatic brain injury: a 9-year observational study. Injury. 2018;49(5):916–920.CrossRefGoogle ScholarPubMed
Harrison, TH, Thomas, SH, Wedel, SK. Success rates of pediatric intubation by a non-physician-staffed critical care transport service. Pediatr Emerg Care. 2004;20(2):101–107.CrossRefGoogle ScholarPubMed
Hansen, M, Eriksson, C, Skarica, B, Meckler, G, Guise, J-M. Safety events in pediatric out-of-hospital cardiac arrest. Am J Emerg Med. 2018;36(3):380–383.CrossRefGoogle ScholarPubMed
Hansen, M, Lambert, W, Guise, J-M, Warden, CR, Mann, NC, Wang, H. Out-of-hospital pediatric airway management in the United States. Resuscitation. 2015;90:104–110.CrossRefGoogle ScholarPubMed
Gerritse, BM, Schalkwijk, A, Pelzer, BJ, Scheffer, GJ, Draaisma, JM. Advanced medical life support procedures in vitally compromised children by a helicopter emergency medical service. BMC Emerg Med. 2010;10:6.CrossRefGoogle ScholarPubMed
Gerritse, BM, Draaisma, JMT, Schalkwijk, A, van Grunsven, PM, Scheffer, GJ. Should EMS-paramedics perform pediatric tracheal intubation in the field? Resuscitation. 2008;79(2):225–229.CrossRefGoogle ScholarPubMed
Gausche, M, Lewis, RJ, Stratton, SJ, et al. Effect of out-of-hospital pediatric endotracheal intubation on survival and neurological outcome. JAMA. 2000;283(6):783–790.CrossRefGoogle ScholarPubMed
Garza, AG, Algren, DA, Gratton, MC, Ma, OJ. Populations at risk for intubation non-attempt and failure in the prehospital setting. Prehosp Emerg Care. 2005;9(2):163–166.CrossRefGoogle Scholar
Fukuda, T, Sekiguchi, H, Taira, T, et al. Type of advanced airway and survival after pediatric out-of-hospital cardiac arrest. Resuscitation. 2020;150:145–153.Google ScholarPubMed
Ehrlich, PF, Seidman, PS, Atallah, O, Haque, A, Helmkamp, J. Endotracheal intubations in rural pediatric trauma patients. J Pediatr Surg. 2004;39(9):1376–1380.CrossRefGoogle ScholarPubMed
Dyson, K, Bray, JE, Smith, K, et al. Paramedic intubation experience is associated with successful tube placement but not cardiac arrest survival. Ann Emerg Med. 2017;70(3):382–390.CrossRefGoogle Scholar
Cooper, A, DiScala, C, Foltin, G, Tunik, M, Markenson, D, Welborn, C. Prehospital endotracheal intubation for severe head injury in children: a reappraisal. Semin Pediatr Surg. 2001;10(1):3–6.CrossRefGoogle ScholarPubMed
Carlson, JN, Gannon, E, Mann, NC, et al. Pediatric out-of-hospital critical procedures in the United States. Pediatr Crit Care Med. 2015;16(8):e260–267.CrossRefGoogle ScholarPubMed
Brownstein, D, Shugerman, R, Cummings, P, Rivara, F, Copass, M. Prehospital endotracheal intubation of children by paramedics. Ann Emerg Med. 1996;28(1):34–39.CrossRefGoogle ScholarPubMed
Boswell, WC, McElveen, N, Sharp, M, Boyd, CR, Frantz, EI. Analysis of prehospital pediatric and adult intubation. Air Med J. 1995;14(3):125–127; discussion 127.CrossRefGoogle ScholarPubMed
Bankole, S, Asuncion, A, Ross, S, et al. First responder performance in pediatric trauma: a comparison with an adult cohort. Pediatr Crit Care Med. 2011;12(4):e166–170.CrossRefGoogle ScholarPubMed
Baker, TW, King, W, Soto, W, Asher, C, Stolfi, A, Rowin, ME. The efficacy of pediatric advanced life support training in emergency medical service providers. Pediatr Emerg Care. 2009;25(8):508–512.CrossRefGoogle ScholarPubMed
Babl, FE, Vinci, RJ, Bauchner, H, Mottley, L. Pediatric pre-hospital advanced life support care in an urban setting. Pediatr Emerg Care. 2001;17(1):5–9.CrossRefGoogle Scholar
Andrew, E, de Wit, A, Meadley, B, Cox, S, Bernard, S, Smith, K. Characteristics of patients transported by a paramedic-staffed Helicopter Emergency Medical Service in Victoria, Australia. Prehosp Emerg Care. 2015;19(3):416–424.CrossRefGoogle ScholarPubMed
Aijian, P, Tsai, A, Knopp, R, Kallsen, GW. Endotracheal intubation of pediatric patients by paramedics. Ann Emerg Med. 1989;18(5):489–494.CrossRefGoogle ScholarPubMed
Koslow, EA, Borgman, MA, April, MD, Schauer, SG. Pediatric prehospital airway management by US forces in Iraq and Afghanistan. Mil Med. 2020;185(9-10):e1435–1439.CrossRefGoogle ScholarPubMed
Padrez, KA, Brown, J, Zanoff, A, Chen, CC, Glomb, N. Development of a simulation-based curriculum for Pediatric prehospital skills: a mixed-methods needs assessment. BMC Emerg Med. 2021;21(1):107.CrossRefGoogle ScholarPubMed
Burns, BJ, Watterson, JB, Ware, S, Regan, L, Reid, C. Analysis of out-of-hospital pediatric intubation by an Australian Helicopter Emergency Medical Service. Ann Emerg Med. 2017;70(6):773–782.CrossRefGoogle ScholarPubMed
Bigelow, AM, Gothard, MD, Schwartz, HP, Bigham, MT. Intubation in pediatric/neonatal critical care transport: national performance. Prehosp Emerg Care. 2015;19(3):351–357.CrossRefGoogle ScholarPubMed
Smith, KA, Gothard, MD, Schwartz, HP, Giuliano, JS, Forbes, M, Bigham, MT. Risk factors for failed tracheal intubation in pediatric and neonatal critical care specialty transport. Prehosp Emerg Care. 2015;19(1):17–22.CrossRefGoogle ScholarPubMed
Shaw, KN, Bachur, RG, Chamberlain, JM, Lavelle, J, Nagler, J, Shook, JE. Fleisher & Ludwig’s Textbook of Pediatric Emergency Medicine, 7e. Philadelphia, Pennsylvania USA: Lippincott Williams & Wilkins; 2016.Google Scholar
Reichert, RJ, Gothard, M, Gothard, MD, Schwartz, HP, Bigham, MT. Intubation success in critical care transport: a multicenter study. Prehosp Emerg Care. 2018;22(5):571–577.CrossRefGoogle ScholarPubMed
Rodríguez, JJ, Higuita-Gutiérrez, LF, Carrillo Garcia, EA, Castaño Betancur, E, Luna Londoño, M, Restrepo Vargas, S. Meta-analysis of failure of prehospital endotracheal intubation in pediatric patients. Emerg Med Int. 2020;2020:7012508.CrossRefGoogle ScholarPubMed
Ono, Y, Tanigawa, K, Kakamu, T, Shinohara, K, Iseki, K. Out-of-hospital endotracheal intubation experience, confidence, and confidence-associated factors among Northern Japanese emergency life-saving technicians: a population-based cross-sectional study. BMJ Open. 2018;8(7):e021858.CrossRefGoogle ScholarPubMed
Maconochie, IK, Aickin, R, Hazinski, MF, et al. Pediatric life support: 2020 international consensus on cardiopulmonary resuscitation and emergency cardiovascular care science with treatment recommendations. Circulation. 2020;142(16_suppl_1):S140–184.CrossRefGoogle ScholarPubMed
Topjian, AA, Raymond, TT, Atkins, D, et al. Part 4: pediatric basic and advanced life support: 2020 American Heart Association guidelines for cardiopulmonary resuscitation and emergency cardiovascular care. Circulation. 2020;142(16_suppl_2):S469–523.CrossRefGoogle ScholarPubMed
Simons, T, Söderlund, T, Handolin, L. Radiological evaluation of tube depth and complications of prehospital endotracheal intubation in pediatric trauma: a descriptive study. Eur J Trauma Emerg Surg. 2017;43(6):797–804.CrossRefGoogle ScholarPubMed
Fawcett, VJ, Warner, KJ, Cuschieri, J, et al. Pre-hospital aspiration is associated with increased pulmonary complications. Surg Infect (Larchmt). 2015;16(2):159–164.Google ScholarPubMed
Supplementary material: File

AlGhamdi et al. supplementary material

AlGhamdi et al. supplementary material
Download AlGhamdi et al. supplementary material(File)
File 66.8 KB