Logan Health, Division of EMS, Kalispell, MT; Air Methods Corporation, Greenwood Village, CO.
Georgetown School of Medicine, Georgetown, Washington DC; Harvard Affiliated Emergency Medicine Program, Boston, MA.
Air Med J. 2024 May-Jun;43(3):210-215. doi: 10.1016/j.amj.2024.02.001. Epub 2024 Mar 8.
Advanced airway management, including the use of rapid sequence intubation (RSI), is fundamental in resuscitation. However, the reported experience with pediatric airway management is limited because of the relatively low number of emergency RSI procedures in children. The aim of this study was to document the experience with pediatric RSI in a large air medical database and explore opportunities for improvement.
All pediatric patients (age < 18 years) undergoing RSI by air medical crews between 2015 and 2019 were included in this analysis. Subjects were divided a priori into 3 age subgroups (0-2 years, 3-8 years, and 9-17 years). The primary variables of interest included overall intubation success, first-attempt intubation success, and first-attempt intubation success without desaturation. The rates of positive-pressure ventilation (PPV) use for preoxygenation and oxygen desaturation were also explored.
A total of 1,091 pediatric RSI patients were included. The overall intubation success rate was 98% (0-2 years = 96%, 3-8 years = 97%, and 9-17 years = 98%), with 91% intubated on the first attempt (0-2 years = 86%, 3-8 years = 90%, and 9-17 years = 92%) and 87% intubated on the first attempt without oxygen desaturation (0-2 years = 80%, 3-8 years = 88%, and 9-17 years = 90%). A sharp decline in intubation success was observed with preoxygenation SpO values < 97% across all patients. Younger patients (0-2 years) had lower initial SpO values and decreased first-attempt success rates with and without desaturation. These patients were less likely to receive PPV during preoxygenation attempts and had lower use of video laryngoscopy or a bougie on the initial intubation attempt.
In this study, we documented high success rates for air medical pediatric RSI. Higher target SpO values may be justified during preoxygenation. Intubation success, PPV use for preoxygenation, video laryngoscopy, and the use of a bougie were lower for younger patients.
高级气道管理，包括使用快速序贯诱导插管（RSI），是复苏的基础。然而，由于儿童中紧急 RSI 程序的数量相对较少，因此小儿气道管理的经验报告有限。本研究的目的是在大型航空医疗数据库中记录小儿 RSI 的经验，并探讨改进的机会。
本分析纳入了 2015 年至 2019 年间航空医疗人员进行 RSI 的所有儿科患者（年龄<18 岁）。受试者预先分为 3 个年龄亚组（0-2 岁、3-8 岁和 9-17 岁）。主要观察变量包括整体插管成功率、首次尝试插管成功率和首次尝试插管无低氧血症的成功率。还探讨了正压通气（PPV）用于预充氧和氧饱和度降低的使用率。
共纳入 1091 例小儿 RSI 患者。整体插管成功率为 98%（0-2 岁=96%，3-8 岁=97%，9-17 岁=98%），91%的患者在首次尝试时插管（0-2 岁=86%，3-8 岁=90%，9-17 岁=92%），87%的患者在首次尝试时插管且无低氧血症（0-2 岁=80%，3-8 岁=88%，9-17 岁=90%）。所有患者的预充氧 SpO 值<97%时，插管成功率明显下降。年龄较小的患者（0-2 岁）初始 SpO 值较低，无论是否出现低氧血症，首次尝试成功率均较低。这些患者在预充氧尝试期间接受 PPV 的可能性较低，并且在初始插管尝试中较少使用视频喉镜或气管插管。
在这项研究中，我们记录了航空医疗小儿 RSI 的高成功率。在预充氧期间，较高的目标 SpO 值可能是合理的。对于年龄较小的患者，插管成功率、预充氧时使用 PPV、视频喉镜和使用气管插管的比例较低。
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