Impact of Pediatric Age Groups on Prehospital Intubation Success

Introduction: Current studies indicate that first-pass success rates for endotracheal intubation (ETI) range from 66% to 91%. Additional studies suggest that basic airway management with a bag-valve mask produces better outcomes in out-of-hospital cardiac arrest (OHCA) than advanced airway management with ETI. Additional data demonstrates decreased success with repetitive prehospital intubation attempts. However, there are limited data evaluating intubation success among pediatric age groups. 

Objective: This study sought to evaluate whether prehospital overall ETI success varied based on patient age.

Methods: This is an IRB-approved retrospective analysis of pediatric ETI from January 1, 2017–December 31, 2017. Data were collected from all pediatric records in the ESO database. All patients aged less than 18 years with an ETI attempt were included. Patients were divided into 6 age groups: neonate (age 0–30 days), infant (31–364 days), toddler (1–3 years), preschool (4–6 years), school-age (7–12 years), and adolescent (13–17 years). A logistic regression was performed to evaluate the influence of patient age on overall ETI success while controlling for patient age, sex, minority status, and receipt of paralytic agents. 

Results: A total of 553 patients were included in the analysis, of which most were male (n=331; 59.9%) and Caucasian (n=384; 69.4%). Adolescents were the most commonly intubated age group (n=164; 29.66%), followed by infants (n=160; 28.93%), toddlers (n=82; 14.82%), school-aged children (n=60; 10.84%), preschoolers (n=45; 8.13%), and neonates (n=42; 7.59%). Compared to adolescents, neonates (OR 0.404; p=0.014) and those patients not receiving paralytics were less likely to obtain overall ETI success (OR 0.404; p=0.049). Neither sex nor minority status were statistically significant predictors of ETI success. 

Conclusions: Compared with adolescents, prehospital professionals are 60% less likely to successfully intubate neonates. In addition, patients are 60% less likely to be successfully intubated when paralytic agents are not used. Further research is necessary to evaluate if provider experience and training influence pediatric patient intubation success rates.