Definitive airway management after prehospital supraglottic rescue airway in pediatric trauma.

Journal Article (Journal Article)

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.

Full Text

Duke Authors

Cited Authors

  • Hernandez, MC; Antiel, RM; Balakrishnan, K; Zielinski, MD; Klinkner, DB

Published Date

  • February 2018

Published In

Volume / Issue

  • 53 / 2

Start / End Page

  • 352 - 356

PubMed ID

  • 29096887

Electronic International Standard Serial Number (EISSN)

  • 1531-5037

Digital Object Identifier (DOI)

  • 10.1016/j.jpedsurg.2017.10.004


  • eng

Conference Location

  • United States