An observational study of paediatric pre-hospital intubation and anaesthesia in 1933 children attended by a physician-led, pre-hospital trauma service

Introduction: Trauma accounts for 16-44% of childhood deaths. The number of severely injured children who require pre-hospital advanced airway intervention is thought to be small but there is little published data detailing the epidemiology of these interventions. This study was designed to evaluate the children who received pre-hospital intubation (with or without anaesthesia) in a high volume, physician-led, pre-hospital trauma service and the circumstances surrounding the intervention.

Methods: We conducted a 12 year retrospective database analysis of paediatric patients attended by a United Kingdom, physician-led, pre-hospital trauma service. All paediatric patients (<16 years of age) that were attended and received pre-hospital advanced airway intervention were included. The total number of pre-hospital intubations and the proportion that received a rapid sequence induction (RSI) were established. To illustrate the context of these interventions the ages, injury mechanisms and intervention success rates were recorded.

Results: Between 1 January 2000 and 31 October 2011 the service attended 1933 children. There were 315 (16.3%) pre-hospital intubations. Of those intubated, 81% received a rapid sequence induction and 19% were intubated without anaesthesia in the setting of near or actual cardiac arrest. Nearly three quarters of the patients were in the age range of 6-15 years with only 3 patients under the age of 1 year. The most common injury mechanisms that required intubation were Road Traffic Crashes (RTC) and 'falls from height'. These accounted for 79% of patients receiving intubation. Intubation success rate was 99.7% with a single failed intubation during the study period.

Conclusion: Pre-hospital paediatric intubation is not infrequent in this high-volume trauma service. The majority of patients received a rapid sequence induction. The commonest injury mechanisms were RTCs and 'falls from height'. Pre-hospital paediatric intubation is associated with a high success rate in this physician-led service.