ABSTRACT 446

Abstract

Background and aims: Prospective safety data on emergency department (ED) intubation in children are limited. Aims: We set out to describe the practice and adverse events of endotracheal intubation in a paediatric ED. Methods: Prospective observational study at a tertiary paediatric ED with an annual census of 82,000. We investigated intubation frequency, indications, methods, airway difficulty and adverse events. Human Research and Ethics Committee waived the need for informed consent. Results: Over a 6 month period in 2013 there were 41 intubations in 39 patients (5/10 000 ED visits). Median age was 5 years, with 25% in infants <1year of age. Indications were: trauma (17%), and medical conditions (83%); most frequently status epilepticus (31%). 30% had cardiovascular compromise, 72% had respiratory failure, and 51% had a GCS <9 prior to intubation. Direct laryngoscopy was used for the initial intubation attempt in 87%, and indirect laryngoscopy (Glidescope) in 12%. Anticipated difficult airway was encountered in 1 (Cormack and Lehane grade 3) and unanticipated difficult airway in 1 (Cormack and Lehane grade 3). First pass success rate without desaturation or hypotension occurred in 51%. 19% required 2 or more attempts for successful intubation. Adverse events occurred in 39%, the most common being hypotension (19%) and desaturation (14%). Conclusions: Data collection is ongoing. Intubation of children in the ED is a low frequency, high risk procedure. The incidence of unanticipated difficult airway is low. The incidence of adverse events is high. Avoidance of hypoxia and hypotension in the peri-intubation setting should be prioritised.