Improving First Attempt Success Rates in Neonatal and Pediatric Critical Care Transport Field Intubations

Abstract

<h3>Aim</h3> To improve first attempt success rates to meet or exceed the national benchmark of 60% for neonatal and 77% for pediatric field intubations by December 2020. Historically, over a ten-year time span (2010 to 2020) the team has averaged 53% and 69% for neonates and pediatrics, respectively. The secondary aim is to establish a group of dedicated providers with additional training in advanced airway management within the team. <h3>Methods</h3> We implemented a quality improvement process aimed to improve first attempt intubation success rates to meet or exceed national benchmarks. CMAC video laryngoscopes were introduced in 2014 and were required as first line for all intubations by 2016. An anesthesia liaison was established, and our team members were provided with dedicated time with anesthesiologists in the operating room starting in 2017. In 2019, we implemented a single discipline (Respiratory therapist) practice for all field intubations and started an annual 3-day OR experience with anesthesia to maintain and enhance their airway skills. Balancing measures included CMAC unavailability or failure, decreased number of providers with airway training, and an educational environment translatable to the field environment. <h3>Results/Conclusions</h3> Over a five-year period, first attempt intubation success rates for our team improved to 60% for neonates and 85% for pediatrics, with the sustained improvement over time. Implementation of consistent time in the operating room with anesthesiology demonstrated the largest improvement in intubation success rates. <h3>Discussion</h3> Our team improved first attempt field intubation success rates by implementation of a standardized competency training program. This process has been sustained over time and remains successful even with a smaller number of crew members trained in airway management skills.