Air Medical Pediatric Rapid Sequence Intubation
Background: Advanced airway management, including the use of rapid sequence intubation (RSI), is a fundamental skill in resuscitation. However, the reported experience with pediatric patients is limited as most institutions do not accumulate a large number of emergency RSI procedures in children.
Objective: To document the experience with pediatric RSI in a large air medical database.
Methods: Air Methods Corporation includes more than 150 bases throughout the United States. Air medical crews, including a flight nurse and flight paramedic, respond to both scene calls and interfacility transports. The RSI procedure includes either etomidate or ketamine for induction followed by paralysis with either succinylcholine or rocuronium. Video or direct laryngoscopy are available, including smaller blades for pediatric patients. Air medical crews document up to 150 data elements regarding the airway management procedure in a protected performance improvement database. All pediatric patients (age less than 18 years) were included in this analysis; patients were divided into three subgroups based on age (0–2 years, 3–8 years, 9–17 years). The primary variables of interest reflected intubation success: overall successful intubation (Overall), first attempt intubation success (FAS), and first attempt intubation success without desaturation (FASWD).
Results: Over a three-year period, a total of 1,149 pediatric patients were identified. Intubation success for all patients and for each subgroup are included in the following table:
Age Group n Overall (%) FAS (%) FASWD (%)
0–2 269 96 87* 82*
3–8 263 97 92 89
9–17 617 98 93 90
All 1,149 97 91 88
*p<0.05 vs. 3–8 years and 9–17 years
Discussion: Overall pediatric RSI success rates were high despite less-than-optimal intubation conditions in the air medical environment. Rates for FAS and FASWD were lower for the youngest patients; this may represent an opportunity for education and training.
