Definitive airway management after prehospital supraglottic rescue airway in pediatric trauma

Matthew C. Hernandez, Ryan M. Antiel, Karthik Balakrishnan, Martin D. Zielinski, Denise B. Klinkner

Research output: Contribution to journalArticle

Abstract

Introduction: Supraglottic airway (SGA) use and outcomes in pediatric trauma are poorly understood. We compared outcomes between patients receiving prehospital SGA versus bag mask ventilation (BVM). Methods: We reviewed pediatric multisystem trauma patients (2005-2016), comparing SGA and BVM. Primary outcome was adequacy of oxygenation and ventilation. Additional measures included tracheostomy, mortality and abbreviated injury scores (AIS). Results: Ninety patients were included (SGA, n = 17 and BVM, n = 73). SGA patients displayed increased median head AIS (5 [4-5] vs 2 [0-4], p = 0.001) and facial AIS (1 [0-2] vs 0 [0-0], p = 0.03). SGA indications were multiple failed intubation attempts (n = 12) and multiple failed attempts with poor visualization (n = 5). Median intubation attempts were 2 [1-3] whereas BVM patients had none. Compared to BVM, SGA patients demonstrated inadequate oxygenation/ventilation (75% vs 41%), increased tracheostomy rates (31% vs 8.1%), and increased 24-h (38% vs 10.8%) and overall mortality (75% vs 14%) (all p. <. 0.05). Conclusions: Escalating intubation attempts and severe facial AIS were associated with tracheostomy. Inadequacy of oxygenation/ventilation was more frequent in SGA compared to BVM patients. SGA patients demonstrate poor clinical outcomes; however, SGAs may be necessary in increased craniofacial injury patterns. These factors may be incorporated into a management algorithm to improve definitive airway management after SGA.

Original languageEnglish (US)
JournalJournal of Pediatric Surgery
DOIs
StateAccepted/In press - 2017

Keywords

  • ATLS
  • Pediatric
  • Prehospital
  • Supraglottic airway
  • Trauma

ASJC Scopus subject areas

  • Surgery
  • Pediatrics, Perinatology, and Child Health

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    Hernandez, M. C., Antiel, R. M., Balakrishnan, K., Zielinski, M. D., & Klinkner, D. B. (Accepted/In press). Definitive airway management after prehospital supraglottic rescue airway in pediatric trauma. Journal of Pediatric Surgery. https://doi.org/10.1016/j.jpedsurg.2017.10.004