Analysis of Out-of-Hospital Pediatric Intubation by an Australian Helicopter Emergency Medical Service

Burns, Brian; Watterson, Joanna B.; Ware, Sandra; Regan, Luke; Reid, Cliff

doi:10.1016/j.annemergmed.2017.03.020

Cited by 25 publications

(32 citation statements)

References 49 publications

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“…1). The characteristics of 40 included studies involving 11,567 children are shown in Table 1 [1,3,[5][6][7][8][9][10]. Fifteen studies (8201 participants) were published from 2015 onwards.…”

Section: Search Resultsmentioning

confidence: 99%

“…Traditionally, ground EMS systems have intubated children without muscle relaxants, but many systems are introducing relaxants into their clinical protocols with the expectation that overall success rates would improve and that intubation could be offered for a wider range of pathologies. There are also recent reports that physician staffed helicopter EMS (PS-HEMS) may produce particularly high procedural success with low complication rates [7][8][9][10].…”

Section: Introductionmentioning

confidence: 99%

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Success and complications by team composition for prehospital paediatric intubation: a systematic review and meta-analysis

et al. 2020

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Background: Clinical team composition for prehospital paediatric intubation may affect success and complication rates. We performed a systematic review and meta-analysis to determine the success and complication rates by type of clinical team. Methods: We searched MEDLINE, EMBASE, and CINAHL for interventional and observational studies describing prehospital intubation attempts in children with overall success, first-pass success, and complication rates. Eligible studies, data extraction, and assessment of risk of bias were assessed independently by two reviewers. We performed a random-effects meta-analysis of proportions. Results: Forty studies (1989 to 2019) described three types of clinical teams: non-physician teams with no relaxants (22 studies, n = 7602), non-physician teams with relaxants (12 studies, n = 2185), and physician teams with relaxants (12 studies, n = 1780). Twenty-two (n = 3747) and 18 (n = 7820) studies were at low and moderate risk of bias, respectively. Non-physician teams without relaxants had lower overall intubation success rate (72%, 95% CI 67-76%) than non-physician teams with relaxants (95%, 95% CI 93-98%) and physician teams (99%, 95% CI 97-100%). Physician teams had higher first-pass success rate (91%, 95% CI 86-95%) than non-physicians with (75%, 95% CI 69-81%) and without (55%, 95% CI 48-63%) relaxants. Overall airway complication rate was lower in physician teams (10%, 95% CI 3-22%) than non-physicians with (30%, 95% CI 23-38%) and without (39%, 95% CI 28-51%) relaxants. Conclusion: Physician teams had higher rates of intubation success and lower rates of overall airway complications than other team types. Physician prehospital teams should be utilised wherever practicable for critically ill children requiring prehospital intubation.

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Section: Search Resultsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Success and complications by team composition for prehospital paediatric intubation: a systematic review and meta-analysis

et al. 2020

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“…Multiple attempts at endotracheal intubation are associated with an increased complication rate . A team of skilled and experienced clinicians can safely undertake endotracheal intubation in the retrieval environment with a high first attempt success rate …”

Section: Discussionmentioning

confidence: 99%

Endotracheal intubation by a specialised paediatric retrieval team

Glasheen

Holmes

Rampersad

et al. 2019

Emerg Medicine Australasia

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Objectives Intubation of critically ill children is an infrequent procedure, and is associated with significant risk. We set out to describe intubations carried out by the Children's Health Queensland Retrieval Service (CHQRS), with the intention to identify areas for improvement in the performance of intubation in the retrieval setting. Methods Paediatric patients undergoing transport while intubated were identified, and cases where intubation occurred after the arrival of the CHQRS team were examined. Results Over the study period of January 2015 to September 2018, 498 intubated retrievals were undertaken; 85 patients were intubated after the arrival of CHQRS; the age range was 1 day to 16.5 years (median 0.5, interquartile range [IQR] 0.11–3 years). The median weight was 6.2 kg (IQR 3.7–16.5 kg). The pathology requiring intubation included respiratory 36 (42.3%), sepsis 21 (24.7%), neurological 11 (12.9%) and trauma 7 (8.2%). A total of 470 of 498 (94.4%) of intubated patients were from regional referral or tertiary hospitals, 28 of 498 (5.6%) were from rural and remote facilities. Of 85 patients, 57 (67.1%) were intubated by CHQRS and 28 (32.9%) were intubated by a doctor from the referring facility. The CHQRS team was more likely to perform the intubation in smaller children (median weight 5.0 vs 9.9 kg, P = 0.03). The mean scene time was 2.8 h. The scene time was shorter if the intubation was performed by CHQRS (mean 2.6 h, median 2.5, IQR 1.8–3.3; median 3, IQR 2.2–3.9; P = 0.048). The scene time was shorter when the intubation was predicted from tasking information (2.6 vs 3.1 h; P = 0.03). Conclusion Paediatric endotracheal intubation is an infrequent procedure in our service. An airway registry could improve documentation and gather information to identify specific training requirements and areas for practice improvement.

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“…A remoção rápida e com medidas de segurança de recém-nascidos (RNs) críticos, como por exemplo, os prematuros extremos e os com malformações congênitas complexas, nascidos em centros que apresentam insuficiência de recursos para Unidades de Terapia Intensiva Neonatal (UTIs) por meio de transporte inter-hospitalar é considerada uma das recomendações do Ministério da Saúde devido sua capacidade de diminuição significativa da mortalidade neonatal por causas evitáveis. No qual, é importante compreender que cerca de 20% das transferências neonatais foram consideradas inadequadas em países desenvolvidos decorrente da presença de erros na regulação médica, equipes sem treinamento para realização do transporte adequado (BURNS, et. al., 2017).…”

Section: Introductionunclassified

“…De acordo com a Portaria nº 2.048 do Ministério da Saúde decreta que as atividades dos serviços de urgência e emergência realizadas uso através do transporte aeromédico (considerado modalidade de Suporte Avançado a Vida) esta indicado em condições de gravidade do quadro clínico no qual o paciente necessita de uma intervenção rápida, o que por via terrestre pelas condições de trânsito se tornaria muito tardio. Sendo assim, o serviço realizado pelo transporte aeromédico caracteriza-se pela abordagem secundária, a introdução de uma estabilização adequada, imobilização e o transporte dos pacientes de pequenos unidades de saúde para o hospital e/ou unidades de referência no Sistema Único de Saúde (SUS) (BURNS, et. al., 2017).…”

Section: Introductionunclassified

Atendimento de pacientes Neonatais realizadas pelo Serviço Aeromédico: Uma Revisão Integrativa / Neonatal Patients Carried Out By Aerometric Service: An Integrating Review

2019

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A remoção rápida e com medidas de segurança de recém-nascidos (RNs) críticos, como por exemplo, os prematuros extremos e os com malformações congênitas complexas, nascidos em centros que apresentam insuficiência de recursos para Unidades de Terapia Intensiva Neonatal (UTIs) por meio de transporte inter-hospitalar é considerada uma das recomendações do Ministério da Saúde devido sua capacidade de diminuição significativa da mortalidade neonatal por causas evitáveis. Objetivo: caracterizar o transporte neonatal através do Serviço Aeromédico Metódos:Trata–se de um estudo de revisão integrativa, com abordagem descritiva e exploratória, sobre o tema: Atendimento de Pacientes Neonatais realizadas pelo Serviço Aeromédico.Para a realização da busca na Biblioteca Virtual da saúde ( BVS), foram utilizadas combinações entre as seguintes palavras-chave, consideradas descritores no DeCS: “Neonatologia”, “Resgate aereo” e “Urgencia”. Os termos foram cruzados como descritores e também como palavras do título e do resumo. A busca foi realizada no período de Junho de 2019.Resultados e discussão:A literatura o Serviço Aeromédico é utilizado principalmente entre RNs de alto risco, no qual existem indicações pré-estabelecidas e com isso possibilita a introdução de melhores abordagens. No qual é necessário a utilização de materiais e protocolos pré-estabelcidos, como também uma equipe preparada para realização dos atendimentos nos pacientes neonatais.Conclusão: Diante dessa perspectiva é possível compreender que o avanço tecnológico alinhado ao desenvolvimento de uma medicina de qualidade pode proporcionar melhores abordagens aos pacientes neonatais e com isso estabelecer uma melhor qualidade de vida e diminuição da morbimortalidade destes pacientes.

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Analysis of Out-of-Hospital Pediatric Intubation by an Australian Helicopter Emergency Medical Service

Cited by 25 publications

References 49 publications

Success and complications by team composition for prehospital paediatric intubation: a systematic review and meta-analysis

Success and complications by team composition for prehospital paediatric intubation: a systematic review and meta-analysis

Endotracheal intubation by a specialised paediatric retrieval team

Atendimento de pacientes Neonatais realizadas pelo Serviço Aeromédico: Uma Revisão Integrativa / Neonatal Patients Carried Out By Aerometric Service: An Integrating Review

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