Paediatric intubation in Scottish emergency departments

Oglesby, Angela J.; Graham, Colin A.; Beard, D.; McKeown, D.W.

doi:10.1046/j.1460-9592.2003.01107.x

Cited by 26 publications

(20 citation statements)

References 24 publications

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“…Furthermore, they completed well-designed airway training programs, including technical and non-technical skill training with high-fidelity simulation when they were junior physicians 11. Some authors have emphasised regular training sessions and training with high-fidelity simulations to improve emergency airway management and teamwork 12 13. Therefore, it is thought that systematic education for ETI, including simulations and intubation quality control through the ETI record, could help non-EM physicians increase their FAS rates.…”

Section: Discussionmentioning

confidence: 99%

What factors affect the success rate of the first attempt at endotracheal intubation in emergency departments?

et al. 2012

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The predicted airway difficulty was the major factor associated with FAS in emergency department ETI on adults regardless of intubator's specialty. Especially in EM physician group, level of training and using of RSI also affecting on first-attempt success. The overall ETI success rate on first attempt was 80.1%, but EM physicians had success rate of 87.3%. Systematic technical and non-technical airway skill training focused on RSI and continuous quality control and ETI recording could help non-EM physicians increase their FAS rate.

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Section: Discussionmentioning

confidence: 99%

What factors affect the success rate of the first attempt at endotracheal intubation in emergency departments?

et al. 2012

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“…15 16 The majority of children in this study were intubated by anaesthetists; this may reflect the ability of the EP to identify patients who need specific anaesthesia input. It may also reflect the fact that the EP is usually the team leader for such emergencies and requires skilled help with the airway as he or she is involved in coordination and overall team organisation for these rare and difficult cases.…”

Section: Discussionmentioning

confidence: 99%

Tracheal intubation in the emergency department: the Scottish district hospital perspective

Stevenson

Graham

Hall

et al. 2007

Emergency Medicine Journal

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Background: Tracheal intubation is the accepted gold standard for emergency department (ED) airway management. It may be performed by both anaesthetists and emergency physicians (EPs), with or without drugs. Objective: To characterise intubation practice in a busy district general hospital ED in Scotland over 40 months between 2003 and 2006. Setting: Crosshouse Hospital, a 450-bed district general hospital serving a mixed urban and rural population; annual ED census 58 000 patients. Methods: Prospective observational study using data collection sheets prepared by the Scottish Trauma Audit Group. Proformas were completed at the time of intubation and checked by investigators. Rapid-sequence induction (RSI) was defined as the co-administration of an induction agent and suxamethonium. Results: 234 intubations over 40 months, with a mean of 6 per month. EPs attempted 108 intubations (46%). Six patients in cardiac arrest on arrival were intubated without drugs. 29 patients were intubated after a gas induction or non-RSI drug administration. RSI was performed on 199 patients. Patients with trauma constituted 75 (38%) of the RSI group. 29 RSIs (15%) were immediate (required on arrival at the ED) and 154 (77%) were urgent (required within 30 min of arrival at the ED). EPs attempted RSI in 88 (44%) patients and successfully intubated 85 (97%). Anaesthetists attempted RSI in 111 (56%) patients and successfully intubated 108 (97%). Anaesthetists had a higher proportion of good views at first laryngoscopy and there was a trend to a higher rate of successful intubation at the first attempt for anaesthetists. Complication rates were comparable for the two specialties. Conclusions: Tracheal intubations using RSI in the ED are performed by EPs almost as often as by anaesthetists in this district hospital. Overall success and complication rates are comparable for the two specialties. Laryngoscopy training and the need to achieve intubation at the first (optimum) attempt needs to be emphasised in EP airway training.

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“…Most children requiring ED airway management are critically ill and require intubation as part of resuscitation or stabilisation prior to transfer to definitive care. Larger international data sets indicate that children intubated in ED have lower rates of successful intubation on the first pass and higher rates of complications than adults …”

Section: Introductionmentioning

confidence: 99%

Paediatric intubation in Australasian emergency departments: A report from the ANZEDAR

Ghedina

Alkhouri

Badge

et al. 2019

Emerg Medicine Australasia

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Objectives: To describe the epidemiology, clinical practice and outcomes of paediatric ED intubation in Australia and New Zealand. Method: Prospectively collected airway management audit data from 43 EDs in Australia and New Zealand that was submitted to the Australia and New Zealand Emergency Department Airway Registry between 2010 and 2015. Results: Paediatric cases accounted for 4.94% (270/5463) of cases (median age = 3, interquartile range [IQR] = 2-9). A median of 5 (IQR = 2-9) intubations were reported per department per year. Most intubations were performed for medical indications (72.2%), including seizure (25.2%) and respiratory failure (15.2%). Patients were physiologically compromised prior to intubation with 69.5% comatose, 50.9% outside of the normal ageadjusted range for respiratory rate, 15.9% hypoxic and 12.6% hypotensive. Complication rate was 33.3% and desaturation was the most common (18.5%). The ED mortality rate was 3.8%. First pass success (FPS) was 80% (95% CI 75.2-84.8). Infants less than 1 year of age had lower FPS, higher rates of difficult laryngoscopy and higher rates of desaturation than other age groups. Conclusion: Paediatric intubation in Australasian EDs is rare from a departmental and individual provider viewpoint. Success rates are similar to contemporary international registries. Complications are common and ongoing collaborative multicentre audit with resultant quality improvement is desirable to facilitate improved success and reduced complications.

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Paediatric intubation in Scottish emergency departments

Abstract: Paediatric intubation in the emergency department is uncommon. Collaboration and appropriate training for doctors in emergency medicine, anaesthesia and paediatrics is essential.

Cited by 26 publications

References 24 publications

What factors affect the success rate of the first attempt at endotracheal intubation in emergency departments?

What factors affect the success rate of the first attempt at endotracheal intubation in emergency departments?

Tracheal intubation in the emergency department: the Scottish district hospital perspective

Paediatric intubation in Australasian emergency departments: A report from the ANZEDAR

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