Interventions designed using quality improvement methods reduce the incidence of serious airway events and airway cardiac arrests during pediatric anesthesia

Spaeth, James P.; Kreeger, Renee Nierman; Varughese, Anna M.; Wittkugel, Eric P.

doi:10.1111/pan.12829

Cited by 23 publications

(13 citation statements)

References 10 publications

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“…Similar quality improvement studies have demonstrated a reduction in intubation related adverse events or cardiac arrest in the pediatric population. Spaeth et al 8 demonstrated a 59% reduction in airway related cardiac arrest in pediatric patients undergoing airway management with anesthesia over 2.5 years. While this study demonstrates the potential for QI interventions to minimize patient risk, the clinical setting in which it takes place (ie, in the OR with anesthesia) is very different from emergency airway management in the PED.…”

Section: Discussionmentioning

confidence: 99%

Peri-Intubation Cardiac Arrest in the Pediatric Emergency Department: A Novel System of Care

Hoehn

Dean

Lautz

et al. 2020

Pediatric Quality &Amp; Safety

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Introduction: Patients with physiologic disorders, such as hypoxemia or hypotension, are at high risk of peri-intubation cardiac arrest. Standardization improves emergency tracheal intubation safety, but no published reports describe initiatives to reduce the risk of cardiac arrest. This initiative aims to improve the care of children at risk of peri-intubation cardiac arrest in a pediatric emergency department (PED). We specifically aimed to increase the number of patients between those with peri-intubation cardiac arrest by 50%, from a baseline of 11–16, over 12-months. Methods: Our multidisciplinary team outlined a theory of improvement and designed interventions aimed at key drivers. The primary intervention was creating a PICU-ED Team (PET) and a checklist to guide the assessment and mitigation of risk for peri-intubation arrest and rapid consultation of the pediatric intensivists. The PET was iteratively refined, and we collected data by a video review of tracheal intubations. Results: Fifty-one patients with risk factors for peri-intubation arrest underwent tracheal -intubation in the PED from January 2016 to March 2020: 14 with PET activation since PET go-live in April 2019. None of the 14 PET patients had a peri-intubation cardiac arrest. Ninety-three percent (13/14) of PET patients were intubated in the PED, and 78% (10/13) of these patients had the first intubation attempt completed by PED physicians (balancing measures). Conclusion: We successfully developed the PET to mitigate the risk of peri-intubation cardiac arrest without significantly reducing key procedural opportunities for the PED. Initial data are promising, but further refinement is needed.

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Section: Discussionmentioning

confidence: 99%

Peri-Intubation Cardiac Arrest in the Pediatric Emergency Department: A Novel System of Care

Hoehn

Dean

Lautz

et al. 2020

Pediatric Quality &Amp; Safety

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“…However, NMBAs can improve the quality of intubation and reduce the incidence of critical respiratory events, especially when airway instrumentation is performed at inadequate levels of anesthesia . Cases of bradycardia and airway damage have been reported when relaxant‐free methods have been used .…”

Section: Introductionmentioning

confidence: 99%

Neuromuscular‐blocking agents for tracheal intubation in pediatric patients (0‐12 years): A systematic review and meta‐analysis

Vanlinthout

Geniets

Driessen

et al. 2020

Pediatric Anesthesia

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Background:The benefit of using neuromuscular-blocking agents to facilitate tracheal intubation in pediatric patients remains unclear due to variations in design, treatments, and results among trials. By combining the available evidence, we aimed to establish whether scientific findings are consistent and can be generalized across various populations, settings, and treatments. Methods:A systematic search for randomized controlled trials, related to the use of neuromuscular-blocking agents for tracheal intubation in American Society of Anesthesiologists class I-II participants (0-12 years), was performed. We considered all randomized controlled trials that studied whether intubation conditions and hemodynamics obtained by using neuromuscular-blocking agents were equivalent to those that were achieved without neuromuscular-blocking agents. We combined the outcomes in Review Manager 5.3 (RevMan, The Cochrane Collaboration) by pairwise random-effects meta-analysis using a risk ratio (RR) for intubation conditions and mean difference for hemodynamic values (mean [95% Confidence Intervals]).Heterogeneity among trials was explored using sensitivity analyses. Results:We identified 22 eligible randomized controlled trials with 1651 participants.Overall, the use of a neuromuscular-blocking agent was associated with a clinically important increase in the likelihood of both excellent (RR = 1.41 [1.19-1.68], I 2 = 76%) and acceptable (RR = 1.13 [1.07-1.19], I 2 = 68%) intubating conditions. There is strong evidence that both unacceptable intubation conditions (RR = 0.35 [0.22-0.46], I 2 = 23%) and failed first intubation attempts (RR = 0.25 [0.14-0.42], I 2 = 0%) were less likely to occur when a neuromuscular-blocking agent was used compared with when it was not. Higher systolic or mean arterial pressures (mean difference = 13.3 [9.1-17.5] mm Hg, I 2 = 69%) and heart rates (mean difference = 15.9 [11.0-20.8] beats/ min, I 2 = 75%) as well as a lower incidence of arrhythmias were observed when tracheal intubation was facilitated by neuromuscular-blocking agents. Conclusion:The use of a neuromuscular-blocking agent during light-to-moderate depth of anesthesia can improve the quality as well as the success rate of tracheal intubation and is associated with better hemodynamic stability during induction of anesthesia. S U PP O RTI N G I N FO R M ATI O N Additional supporting information may be found online in the Supporting Information section. How to cite this article: Vanlinthout LE, Geniets B, Driessen JJ, et al. Neuromuscular-blocking agents for tracheal intubation in pediatric patients: A systematic review and meta-analysis.

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“…Since that time, QI and SA have been taught by medical societies, schools, and hospitals, and are now practiced in the USA, Europe, Japan, Singapore, and Australia. As QI and SA spread, they have improved patient safety in these countries, including pediatric perioperative care . Whether QI and SA can improve perioperative safety in middle‐ and low‐income countries has remained a question.…”

mentioning

confidence: 99%

Quality Improvement and Safety Analytics can improve perioperative safety for children in developing countries

Subramanyam

Isserman

Maddirala

et al. 2019

Pediatric Anesthesia

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Interventions designed using quality improvement methods reduce the incidence of serious airway events and airway cardiac arrests during pediatric anesthesia

Cited by 23 publications

References 10 publications

Peri-Intubation Cardiac Arrest in the Pediatric Emergency Department: A Novel System of Care

Peri-Intubation Cardiac Arrest in the Pediatric Emergency Department: A Novel System of Care

Neuromuscular‐blocking agents for tracheal intubation in pediatric patients (0‐12 years): A systematic review and meta‐analysis

Quality Improvement and Safety Analytics can improve perioperative safety for children in developing countries

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