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

Abstract

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.

Lebensrettende Maßnahmen bei Kindern (Paediatric Life Support, PLS)

“…Wir haben in unsere Analyse eine Leitlinie aufgenommen [ 24 ], 3 SR [ 148 – 150 ], 9 narrative Reviews [ 151 – 159 ], 2 RCT [ 160 , 161 ] und 27 Beobachtungsstudien (Anhang RR 4.1; [ 162 – 188 ]).…”

Success and complications by team composition for prehospital pediatric intubation: children also need physicians!

“…To the Editor, Garner et al [1] reported that physician teams had higher rates of pediatric intubation success and lower rates of overall airway complications than other team types and that prehospital teams including physicians should be mobilized whenever practicable for critically ill children requiring prehospital intubation.…”

“…Third, from a methodological point of view, we wonder why the authors did not consider an alternative group of physicians who do not use muscle relaxants. Indeed, emergency services traditionally intubate children without muscle relaxants [1], and the results of Garner et al strongly suggest an effect of muscle relaxants on outcomes, whoever the operator. Fourth, the wide age range used for pediatric definition possibly influences the results because airway access conditions vary greatly between infancy and adolescence.…”

Pediatric Prehospital Advanced Airway Management by Anesthesiologist and Nurse Anesthetist Staffed Critical Care Teams

“…Children constitute roughly only five percent of the caseload of Emergency Medical Services (EMS), with an incidence of prehospital TI of 0.1% to 5.0% in those pediatric patients. 6 Unsurprisingly, studies confirm increased rates of TI failure and complications in pediatric patients. 6,7 Authors conclude that specialist competence in pediatric advanced airway management is crucial.…”

“…6 Unsurprisingly, studies confirm increased rates of TI failure and complications in pediatric patients. 6,7 Authors conclude that specialist competence in pediatric advanced airway management is crucial. 1,2,[7][8][9] Research into pediatric prehospital airway management is considered a prioritized research area.…”