Faculty Collaboration Database

The Effects of Pediatric Advanced Life Support Guidelines on Pediatric Trauma Airway Management. Pediatr Emerg Care 2016 Aug;32(8):499-503

Date

06/23/2016

Pubmed ID

27331580

DOI

10.1097/PEC.0000000000000759

Scopus ID

2-s2.0-84975452583 (requires institutional sign-in at Scopus site)   4 Citations

Abstract

OBJECTIVE: Recent Pediatric Advanced Life Support (PALS) guidelines have deemphasized the use of advanced airways in short transport. It is unclear if guideline recommendations have altered practice. We sought to determine if a temporal change exists in the number of prehospital pediatric trauma intubations since the 2005 PALS guidelines update.

METHODS: This is an institutional review board-approved, retrospective, single-center study. Reviewed all pediatric trauma activations where patients younger than 19 years were intubated at the scene, en route or at the level 1 trauma center during 2006 to 2011. Specific complications collected were esophageal intubations, mainstem intubations and need for re-intubations.

RESULTS: There were 1012 trauma activations, 1009 pediatric patients, 300 (29.7%) intubated during transport to Children's Hospital of Wisconsin Pediatric Trauma Center (PTC) or upon arrival. Mean age of 9.5 ± 5.9 years. Fifty-seven percent (n = 172) were intubated before PTC, 31.7% (n = 95) field intubations, 25.7% (n = 77) outside facility intubations. 44% (n = 132) at PTC. Age was not a significant variable. There was no difference in the proportion of injured children requiring intubation who were intubated before arrival to the PTC. Those intubated in the field versus a facility had significantly increased mortality (P = 0.0002), longer hospital days (P = 0.0004) including intensive care unit days (P = 0.0003) and ventilator days (P = 0.0003) even when adjusted for illness severity.

CONCLUSIONS: There was no significant change in the proportion of pretrauma room intubations following the 2005 PALS guidelines even when adjusted for illness or injury severity. Children injured farther from the PTC and more severely injured children were more likely to be intubated before arrival at the PTC.

Author List

Sperka J, Hanson SJ, Hoffmann RG, Dasgupta M, Meyer MT

Author

Michael T. Meyer MD Chief, Professor in the Pediatrics department at Medical College of Wisconsin

MESH terms used to index this publication - Major topics in bold

Adolescent
Airway Management
Child
Child, Preschool
Disease Management
Emergency Medical Services
Female
Humans
Intubation, Intratracheal
Male
Practice Guidelines as Topic
Retrospective Studies
Trauma Centers