Pre-hospital advanced airway management in children: a challenge that training can handle.

We respond to the Tarpgaard et al. article reporting on pre-hospital endotracheal intubation (PHETI) success and complications by Danish critical care teams including critical care anaesthetists. We compare the authors' results with previously published results from our service's experience with PHETI in a similar patient population, also with physician and paramedic medical teams. From 25 children <16 years of age, the Danish study reports overall success, and first-pass success, and complication rates of 96, 75 and 20%, respectively. A recently published study of 82 patients that we completed revealed the following results: 100, 91 and 14%, respectively. We propose training and operating protocols we believe contribute to this relative success in paediatric PHETI.

Analysis of Out-of-Hospital Pediatric Intubation by an Australian Helicopter Emergency Medical Service.

STUDY OBJECTIVE: We examine first-look success in emergency pediatric intubation by a physician-staffed helicopter emergency medical service (EMS). METHODS: A database analysis of all pediatric (<16 years) intubations during a 64-month period was undertaken, using data from a prospectively enrolled electronic airway registry form. Recorded findings included patient demographics, operator background, airway intervention including intubation attempts, complications, and critical timings. RESULTS: Eighty-two subjects were identified during the 64-month study. All patients were successfully intubated. The overall first-look success rate was 75 of 82 (91%), registrars achieving a first-look success rate of 26 of 26 (100%), consultants 16 of 17 (94%), and paramedics 33 of 39 (85%). Overall complication rate was 14%; 84% of cases were rapid sequence induction, whereas 16% were "cold intubations." Difficult airway indicators were present in 77% of patients. CONCLUSION: A high first-look success rate for pediatric intubation was achieved by adult helicopter EMS physicians and intensive care paramedics. To our knowledge, this compares favorably with the rate in published literature in pediatric emergency departments and critical care units.