First-Pass Success Rates of Out-Of-Hospital Advanced Airway Management in Adults and Children

Introduction—Prehospital advanced airway management (AAM, including endotracheal intubation [ETI] and supraglottic airway insertion [SGA]) of children is difficult. Multiple AAM attempts are associated with increased adverse events.

Objective—To compare advanced airway management first-pass success (FPS) rates between adults and children in a national cohort of EMS agencies.

Methods—The study reviewed 2017 clinical data from the ESO Solutions national database encompassing more than 2,000 EMS agencies. Subjects were all patients receiving any AAM attempts. FPS was self-reported. Using multivariable logistic regression, we compared the odds of ETI FPS between adults (age 14 years or more) and children (age less than 14 years), adjusting for gender, ethnicity, primary impression, and drug facilitation. The analysis was repeated for SGA FPS. First-pass success rates between pediatric age subsets (less than 1 year, 1–5 years, 6–10 years, 11–14 years) were also compared.

Results—During the one-year period, 731 EMS agencies attempted AAM on 29,369 patients (median=18 per agency, IQR 6, 43), including 28,846 (98.2%) adults and 523 (1.8%) children. Most AAM were ETI: adults 22,049 (76.4%) and children 471 (90.1%). Most patients were white (65%), male (60.5%), and underwent AAM for cardiac arrest (67.3%). ETI FPS was lower in children than adults (58.6% vs. 72.7%; OR 0.56; 95% CI, 0.46–0.68; p<0.001). SGA FPS was similar between children and adults (84.6% vs. 89.8%; OR 0.62; 95% CI, 0.30–1.43, p=0.31). Among children ETI FPS was higher with increasing age: less than 1 year 55.7% (42.4%–68.5%), 1 to less than 6 years 54.8% (48.9%–60.7%), 6 to less than 10 years 62.7% (48.1%–75.9%), 10 to less than 14 years 73.5% (61.4%–83.5%, p<0.001). Among children SGA FPS was not associated with increasing age group: less than 1 80.0% (28.4%–99.5%), 1 to less than 6 95.2% (76.2%–99.9%), 6 to less than 10 57.1% (18.4%–90.1%), and 10 to less than 14 84.2% (60.4%–96.6%, p=0.44).

Conclusion—ETI FPS is lower in children than adults. SGA FPS does not differ between children and adults.