Definitive airway management after prehospital supraglottic rescue airway in pediatric trauma

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.