Abstract
Prehospital care is essential for airway preservation in pediatric patients who require early endotracheal intubation to improve oxygenation and prevent aspiration. However, high frequencies of failure of endotracheal intubation have been reported for this age group. We aimed to analyze the frequency of failure of endotracheal intubation in pediatric patients within a prehospital context and compare it with adult patients. Thus, a systematic revision of literature with a meta-analysis was performed using a study search and selection strategy ensuring extensiveness, sensitivity, and reproducibility. Meta-analyses were performed for odds ratio, DerSimonian and Laird's Q test was used to assess heterogeneity, and Egger and Begg's test was used to assess publication bias. Overall, 17 papers and 8772 patients were included, and the main cause of prehospital care was assessed to be trauma. Failed endotracheal intubation frequency was 0.4%–52.6% in pediatric patients. The most frequent complication was with esophageal intubation. Forest plot suggests that risk of failure during intubation of pediatric patients is 3.54 fold higher than that observed for adults. It was concluded that airway management in pediatric patients within a prehospital context is a challenge for prehospital care providers because it entails clear physiological and anatomical differences and a low frequency of exposure to this kind of events as opposed to adults. These differences support a widely higher risk of failure of intubation, suggesting the necessity of consistently trained prehospital care providers to ensure proficiency in technique as well as availability of the required equipment.
Highlights
Prehospital care is an essential medical service during urgency and emergency situations because early care at the place where the event occurs helps to decrease avoidable mortality, morbidity, and future disabilities [1,2,3,4]
Prehospital care is important in the pediatric population because trauma is the most common cause of morbidity and mortality in this age group [5, 6], and endotracheal intubation is usually required in patients with severe traumatic injuries to improve oxygenation and prevent aspiration [7]
19 papers were included in the qualitative summary, which were published between 1989 and 2018, and their studies were performed in different American states, followed by several European countries (Switzerland, Germany, and Belgium)
Summary
Prehospital care is an essential medical service during urgency and emergency situations because early care at the place where the event occurs helps to decrease avoidable mortality, morbidity, and future disabilities [1,2,3,4]. Former papers have documented that children who arrive at the hospital without a pulse and with apnea have a lower probability of survival, and if they do survive, there is a higher probability of neurological deficit [9]. In this context, appropriate airway management in pediatric patients is fundamental to reduce complications that increase morbidity and mortality in this population; proper knowledge of anatomy and physiology is required to follow a systematic and efficacious approach. There are different devices for the airway approach, such as bag valve mask, supraglottic devices, or endotracheal tubes, with orotracheal intubation (OTI) being the gold standard in airway management [12,13,14,15]
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