Objective

Airway management is an important priority in the care of critically ill children. We sought to provide updated estimates of the epidemiology of pediatric out-of-hospital airway management and ventilation interventions in the United States.

Methods

We used data from the 2019 National Emergency Medical Services Information System (NEMSIS) data set. We performed a descriptive analysis of all patients <18 years receiving one or more of the following: bag-valve-mask ventilation (BVM), tracheal intubation (TI), supraglottic airway (SGA) insertion, continuous positive airway pressure (CPAP), bilevel positive airway pressure (BiPAP) and surgical airway placement. We determined success and complication rates for each airway procedure.

Results

Among 1,148,943 pediatric patient care encounters, airway and ventilation interventions occurred in 22,637 (1,970 per 100,000 pediatric Emergency Medical Services (EMS) activations), including 64% <11 years old, 56.1% male, 16.9% cardiac arrest, 16.6% injured, and 83.9% in urban areas. Airway interventions included: BVM 3,997 (17.7% of pediatric airway encounters), TI 3,165 (14.0%), SGA 582 (2.6%), CPAP/BiPAP 331 (1.5%) and surgical airway 29 (0.1%). TI success was 75.2% (95% CI 73.7-76.7%) and lowest for the 0-1 month age group (56.8%; 49.2-64.2%). SGA success was 88.0% (95% CI 85.1-90.6%). Vomiting was the most common airway complication (n=223, 1%).

Conclusions

BVM and advanced airway management occur in 1 of every 51 pediatric EMS encounters. BVM is the most commonly prehospital pediatric airway management technique, followed by TI and SGA insertion. These data provide contemporary perspectives of pediatric prehospital airway management.

中文翻译：

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2019年国家紧急医疗服务信息系统数据集中院外儿科气道管理的流行病学

客观的

气道管理是重症儿童护理中的一个重要优先事项。我们试图提供对美国儿科院外气道管理和通气干预流行病学的最新估计。

方法

我们使用了来自 2019 年国家紧急医疗服务信息系统 (NEMSIS) 数据集的数据。我们对所有接受以下一项或多项治疗的 <18 岁患者进行了描述性分析：气囊-瓣膜-面罩通气 (BVM)、气管插管 (TI)、声门上气道 (SGA) 插入、持续气道正压通气 (CPAP)、双水平气道正压通气 (BiPAP) 和手术气道放置​​。我们确定了每个气道手术的成功率和并发症发生率。

结果

在 1,148,943 例儿科患者护理中，22,637 例（每 100,000 例儿科紧急医疗服务 (EMS) 激活 1,970 例）发生了气道和通气干预，其中 64% <11 岁，56.1% 男性，16.9% 心脏骤停，16.6% 受伤，以及83.9%在城市地区。气道干预包括：BVM 3,997（17.7% 的儿科气道遭遇）、TI 3,165 (14.0%)、SGA 582 (2.6%)、CPAP/BiPAP 331 (1.5%) 和手术气道 29 (0.1%)。TI 成功率为 75.2% (95% CI 73.7-76.7%)，0-1 月龄组最低 (56.8%；49.2-64.2%)。SGA 成功率为 88.0% (95% CI 85.1-90.6%)。呕吐是最常见的气道并发症（n=223, 1%）。

结论

每 51 例儿科 EMS 病例中有 1 例发生 BVM 和高级气道管理。BVM 是最常用的院前儿科气道管理技术，其次是 TI 和 SGA 插入。这些数据提供了儿科院前气道管理的当代观点。