Abstract 269: Tracheal Intubation During Pediatric CPR: A Videographic Assessment

Abstract

Background: Pediatric cardiopulmonary resuscitation (CPR) continues to emphasize the inclusion of ventilation along with chest compressions. Tracheal intubation (TI) provides the most stable and effective means of ventilation, but performing TI is frequently associated with interruptions in CPR. Published data describing success with TI during CPR and quantifying CPR interruptions during TI in children is lacking. Objectives: To describe the frequency, duration, and outcomes of TI attempts during CPR in children in a tertiary pediatric ED, and to describe the interruptions in CPR associated with TI performance. Methods: Resuscitations in a tertiary pediatric ED are videorecorded as part of a continuous quality improvement project. Pediatric patients receiving CPR under videorecorded conditions in whom TI was attempted were prospectively identified and eligible for inclusion. Patients whose airway management did not include laryngoscopy (e.g. fiberoptic, surgical) were excluded. Data on intubation attempts (first attempt success tube placement, laryngoscopy time) and chest compressions (interruptions, duration of pauses) were collected. Univariate analysis of first attempt success was made between TI attempts with and without interruption in compressions. Results: Between November 2011 and April 2013, 22 patients had tracheal intubation (TI) attempts performed during cardiac arrest; a total of 44 attempts at TI occurred during CPR. 18/44 (41%) TI attempts had an associated interruption in CPR; the median duration in CPR interruption was 20 seconds (range 7 - 48). TI was successful in 17/20 patients (85%). Overall first attempt success at TI was 7/20 (35%); a median of 2 attempts were made per patient. TI attempts without interruption in CPR were successful in 6/22 (27%) compared to 5/11 (45%) when CPR was paused (p < 0.001). Median laryngoscopy time was 35 seconds (range 13-89). Conclusions: Among pediatric ED patients, TI during CPR results in frequent and prolonged interruptions in CPR. Successful TI is more common when CPR is paused. Future studies should examine the relationship between TI and outcomes in pediatric cardiac arrest patients.