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Intubation

Date Last Search Run: Aug 01, 2024
Table last updated: Jun 08, 2024
Data last added: May 27, 2024

Recommendation RECOMMENDATION FOR INTERVENTION
STRENGTH OF EVIDENCE FOR INTERVENTION   SUPPORTIVE (Green) NEUTRAL (Yellow) AGAINST (Red) NOT YET GRADED (White)
1 (strong evidence exists)  
2 (fair evidence exists)  
3 (weak evidence exists)    


Interventions

Bougie
Level Direction Primary Outcome Patient/Process Setting Reference
II Neutral (Yellow) Success Process ED-MD Prekker ME, Bjorklund AR, Myers C, et al. The Pediatric Bougie for the First Tracheal Intubation Attempt in Critically Ill Children. Ann Emerg Med 2023; 81(6):667-76 Medline

Cricoid Pressure
Level Direction Primary Outcome Patient/Process Setting Reference

Direct Laryngoscopy (No airway reflexes)
Level Direction Primary Outcome Patient/Process Setting Reference
I Neutral (Yellow) Survival to hospital discharge and neurological status at discharge Patient PH-Paramedic Gausche M., Lewis R., Stratton, et al. Effect of out-of-hospital pediatric endotracheal intubation on survival and neurological outcome. JAMA 2000; 283:783-98. Medline
I Opposes (Red) Error Rate Process PH-Paramedic Hansen M., Eriksson C., Skarica B., Meckler G., Guise JM. Safety events in pediatric out-of-hospital cardiac arrest. Am J Emerg Med 2018; 36(3):380-383. Medline
II Supportive (Green) 1 month neurologically favourable survival Patient Ohashi-Fukuda N., Fukuda T., Doi K., Morimura N. Effect of prehospital advanced airway management for pediatric out-of-hospital cardiac arrest. Resuscitation 2017; 114:66-72. Medline
II Neutral (Yellow) First pass success Process Eisenberg MA., Green-Hopkins I., Werner H., Nagler J. Comparison Between Direct and Video-assisted Laryngoscopy for Intubations in a Pediatric Emergency Department. Academic emergency medicine 2016; 23(8):870-7. Medline
II Neutral (Yellow) Survival to hospital discharge Process PH-Paramedic Hansen ML., Lin A., Eriksson C., Daya M., McNally B., Fu R., et al. A comparison of pediatric airway management techniques during out-of-hospital cardiac arrest using the CARES database. Resuscitation 2017; 120 51-6. Medline
II Neutral (Yellow) mortality, survival, and neurologic outcomes Patient PH-Paramedic & CCT Weihing VK, Crowe EH, Wang HE, Ugalde IT. Prehospital airway management in the pediatric patient: A systematic review. Acad Emerg Med 2021. Medline
II Neutral (Yellow) Overall mortality Patient Other Weihing VK, Crowe EH, Wang HE, Ugalde IT. Prehospital airway management in the pediatric patient: A systematic review. Acad Emerg Med 2021. Medline
III Supportive (Green) First look success Process Burns BJ., Watterson JB., Ware S., Regan L., Reid C. Analysis of Out-of-Hospital Pediatric Intubation by an Australian Helicopter Emergency Medical Service. Ann Emerg Med 2017; 70(6):773-82.e4. Medline
III Supportive (Green) ETI success Process SIM Fonte M., Oulego-Erroz I., Nadkarni L., Sanchez-Santos L., et al. A randomized comparison of the Glidescope video laryngoscope to the standard laryngoscopy for intubation by pediatric residents in simulated easy and difficult infant airway scenarios. Pediatr Emerg Care 2011; 27(5):398-402. Medline
III Supportive (Green) Intubation success rate Patient SIM Szarpak L., Kurowski A., Czyzewski L., Madziala M., Truszewski Z. Comparison of infant intubation through the TruView EVO2, TruView PCD, and miller laryngoscope by paramedics during simulated infant cardiopulmonary resuscitation: A randomized crossover manikin study. Am J Emerg Med 2015; 33(7):872-875. Medline
III Supportive (Green) Time to ETI Patient SIM Szarpak L., Kurowski A., Czyzewski L., Rodriguez-Nunez A. Video rigid flexing laryngoscope (RIFL) vs miller laryngoscope for tracheal intubation during pediatric resuscitation by paramedics: A simulation study. Am J Emerg Med 2015; 33(8):1019-1024. Medline
III Supportive (Green) Time to ETI Patient SIM Szarpak L., Truszewski Z., Czyzewski L., Kurowski A., Bogdanski L., Zasko P. Child endotracheal intubation with a clarus levitan fiberoptic stylet vs macintosh laryngoscope during resuscitation performed by paramedics: A randomized crossover manikin trial. Am J Emerg Med 2015; 33(11):1547-1551. Medline
III Supportive (Green) Endotracheal intubation (ETI) attempts, success rates Patient Thomas S., Judge T., Lowell MJ., et al. Airway management success and hypoxemia rates in air and ground critical care transport: A prospective multicenter study. Prehosp Emerg Care 2010; 14(3):283. Medline
III Neutral (Yellow) Complications Patient PH-Paramedic Brownstein D., Shugerman R., Cummings P., et al. Prehospital endotracheal intubation of children by paramedics. Ann Emerg Med 1996; 28:34-9. Medline
III Neutral (Yellow) time to ventilation Process SIM Chen L., Hsiao AL. Randomized trial of endotracheal tube versus laryngeal mask airway in simulated prehospital pediatric arrest. Pediatrics 2008; 122(2):e294-7. Medline
III Neutral (Yellow) Insertion speed Process SIM Mitchell MS., Lee White M., King WD., Wang HE. Paramedic King Laryngeal Tube airway insertion versus endotracheal intubation in simulated pediatric respiratory arrest. Prehosp Emerg Care 2012; 16(2):284-8. Medline
III Neutral (Yellow) Time to ETI Patient SIM Szarpak L., Czyzewski L., Kurowski A. Comparison of the pentax, truview, GlideScope, and the miller laryngoscope for child intubation during resuscitation. Am J Emerg Med 2015; 33(3):391-395. Medline
III Neutral (Yellow) Time to ETI Patient SIM Szarpak L., Karczewska K., Czyzewski L., Kurowski A. A randomized comparison of the laryngoscope with fiber optic reusable flexible tip english macintosh blade to the conventional macintosh laryngoscope for intubation in simulated easy and difficult child airway with chest compression scenarios. Am J Emerg Med 2015; 33(7):951-956. Medline
III Neutral (Yellow) Intubation success rate Patient SIM Szarpak L., Karczewska K., Evrin T., Kurowski A., Czyzewski L. Comparison of intubation through the McGrath MAC, GlideScope, AirTraq, and miller laryngoscope by paramedics during child CPR: A randomized crossover manikin trial. Am J Emerg Med 2015; 33(7):946-950. Medline
III Neutral (Yellow) time to intubation Process Szarpak L., Truszewski Z., Czyzewski L., Gaszynski T., Rodriguez A. A comparison of the McGrath-MAC and Macintosh laryngoscopes for child tracheal intubation during resuscitation by paramedics. A randomized, crossover, manikin study. Am J Emerg Med 2016; 34(8):1338-41. Medline
III Neutral (Yellow) Esophageal placement Patient PH-Paramedic Vilke GM., Steen PJ., Smith AM., et al. Out-of-hospital pediatric intubation by paramedics: the San Diego experience. J Emerg Med 2002; 22(1):71-4. Medline
III Opposes (Red) Time to ventilation Process SIM Byars DV., Brodsky RA., Evans D., Lo B., Guins T., Perkins AM. Comparison of direct laryngoscopy to pediatric king LT-D in simulated airways. Pediatr Emerg Care 2012; 28(8):750-2. Medline
III Opposes (Red) Success rate Process PH-Paramedic Denver Metro Airway Study Group. A Prospective Multicentre Evaluation of Prehospital Airway Management in a Large Metropolitan Region. Prehospital Emergency Care 2009; 13(3):304-10. Medline
X Not Yet Graded (White) - Amagasa S, Iwamoto S, Kashiura M, Yasuda H, Kishihara Y, Uematsu S. Early Versus Late Advanced Airway Management for Pediatric Patients With Out-of-Hospital Cardiac Arrest. Ann Emerg Med. March 2024; 83(3):185-95. Medline
X Not Yet Graded (White) - Amagasa S, Utsumi S, Moriwaki T, et al. Advanced airway management for pediatric out-of-hospital cardiac arrest: A systematic review and network meta-analysis. Am J Emerg Med 2023; 68:161-9. Medline

Direct Laryngoscopy (with airway reflexes)
Level Direction Primary Outcome Patient/Process Setting Reference
I Neutral (Yellow) Survival to hospital discharge and neurological status at discharge Patient PH-Paramedic Gausche M., Lewis R., Stratton, et al. Effect of out-of-hospital pediatric endotracheal intubation on survival and neurological outcome. JAMA 2000; 283:783-98. Medline
I Neutral (Yellow) Differences in SpO2 and PeCO2 Patient OR Sinha A., Sharma B., Sood J. ProSeal as an alternative to endotracheal intubation in pediatric laparoscopy. Paediatr Anaesth 2007; 17(4):327-332. Medline
II Neutral (Yellow) Survival Patient PH-Paramedic Weihing VK, Crowe EH, Wang HE, Ugalde IT. Prehospital airway management in the pediatric patient: A systematic review. Acad Emerg Med 2021. Medline
III Neutral (Yellow) Complications Patient PH-Paramedic Brownstein D., Shugerman R., Cummings P., et al. Prehospital endotracheal intubation of children by paramedics. Ann Emerg Med 1996; 28:34-9. Medline
III Neutral (Yellow) First look success Process Burns BJ., Watterson JB., Ware S., Regan L., Reid C. Analysis of Out-of-Hospital Pediatric Intubation by an Australian Helicopter Emergency Medical Service. Ann Emerg Med 2017; 70(6):773-82.e4. Medline
III Neutral (Yellow) Esophageal placement Patient PH-Paramedic Vilke GM., Steen PJ., Smith AM., et al. Out-of-hospital pediatric intubation by paramedics: the San Diego experience. J Emerg Med 2002; 22(1):71-4. Medline
III Opposes (Red) Success Patient In-Patient Denver Metro Airway Study Group. A Prospective Multicentre Evaluation of Prehospital Airway Management in a Large Metropolitan Region. Prehospital Emergency Care 2009; 13(3):304-10. Medline

ETI via a SGA device
Level Direction Primary Outcome Patient/Process Setting Reference
I Neutral (Yellow) First attempt success Process OR Jagannathan N., Sohn LE., Mankoo R., Langen KE., Mandler T. A randomized crossover comparison between the Laryngeal Mask Airway-Unique and the air-Q intubating laryngeal airway in children. Paediatr Anaesth 2012 Feb; 22(2):161-7. Medline

Laryngeal Manipulation
Level Direction Primary Outcome Patient/Process Setting Reference
III Neutral (Yellow) Single attempt ETI success rate Process SIM Samuel N., Winkler K., Peled S., Krauss B., Shavit I. External laryngeal manipulation does not improve the intubation success rate by novice intubators in a manikin study. Am J Emerg Med 2012; 30(9):2005-10. Medline

Lighted Stylet
Level Direction Primary Outcome Patient/Process Setting Reference
I Opposes (Red) Success, Number of attempts Process OR Berns SD., Patel RI., Chamberlain JM. Oral intubation using a lighted stylet vs direct laryngoscopy in older children with cervical immobilization. Acad Emerg Med 1996; 3(1):34-40. Medline
III Supportive (Green) Success rate Process SIM MacNab AJ., MacPhail I., MacNab MK., Noble R., O'Flaherty D. A comparison of intubation success for paediatric transport team paramedics using lighted vs regular tracheal tube stylets. Paediatr Anaesth 1998; 8(3):215-20. Medline

Optical Laryngoscopes
Level Direction Primary Outcome Patient/Process Setting Reference
II Supportive (Green) Intubation success Process SIM Komasawa N., Atagi K., Ueki R., Nishi S., Kaminoh Y., Tashiro C. Comparison of optic laryngoscope Airtraq((R)) and Miller laryngoscope for tracheal intubation during infant cardiopulmonary resuscitation. Resuscitation 2011; 82(6):736-9. Medline
III Supportive (Green) Intubation success rate Patient SIM Szarpak L., Kurowski A., Czyzewski L., Madziala M., Truszewski Z. Comparison of infant intubation through the TruView EVO2, TruView PCD, and miller laryngoscope by paramedics during simulated infant cardiopulmonary resuscitation: A randomized crossover manikin study. Am J Emerg Med 2015; 33(7):872-875. Medline
III Supportive (Green) Time to ETI Patient SIM Szarpak L., Truszewski Z., Czyzewski L., Kurowski A., Bogdanski L., Zasko P. Child endotracheal intubation with a clarus levitan fiberoptic stylet vs macintosh laryngoscope during resuscitation performed by paramedics: A randomized crossover manikin trial. Am J Emerg Med 2015; 33(11):1547-1551. Medline
III Neutral (Yellow) Time to ETI Patient SIM Szarpak L., Karczewska K., Czyzewski L., Kurowski A. A randomized comparison of the laryngoscope with fiber optic reusable flexible tip english macintosh blade to the conventional macintosh laryngoscope for intubation in simulated easy and difficult child airway with chest compression scenarios. Am J Emerg Med 2015; 33(7):951-956. Medline

Pain Control
Level Direction Primary Outcome Patient/Process Setting Reference

Video Visualization ( e.g. Glidescope)
Level Direction Primary Outcome Patient/Process Setting Reference
II Supportive (Green) First-pass success Process Other Dean P, Edmunds K, Shah A, Frey M, Zhang Y, Boyd S, et al. Video Laryngoscope Screen Visualization and Tracheal Intubation Performance: A Video-Based Study in a Pediatric Emergency Department. Ann Emerg Med 2022; 79(4):323–32. Medline
II Supportive (Green) First pass success Process ED-MD Eisenberg MA., Green-Hopkins I., Werner H., Nagler J. Comparison Between Direct and Video-assisted Laryngoscopy for Intubations in a Pediatric Emergency Department. Academic emergency medicine 2016; 23(8):870-7. Medline
II Supportive (Green) Successful endotracheal intubation Patient ED-MD Miller KA, Dechnik A, Miller AF, D'Ambrosi G, et al. Video-Assisted Laryngoscopy for Pediatric Tracheal Intubation in the Emergency Department: A Multicenter Study of Clinical Outcomes. Ann Emerg Med 2023; 81(2):113-22. Medline
III Supportive (Green) Intubation success rate Patient SIM Szarpak L., Karczewska K., Evrin T., Kurowski A., Czyzewski L. Comparison of intubation through the McGrath MAC, GlideScope, AirTraq, and miller laryngoscope by paramedics during child CPR: A randomized crossover manikin trial. Am J Emerg Med 2015; 33(7):946-950. Medline
III Supportive (Green) Time to ETI Patient SIM Szarpak L., Kurowski A., Czyzewski L., Rodriguez-Nunez A. Video rigid flexing laryngoscope (RIFL) vs miller laryngoscope for tracheal intubation during pediatric resuscitation by paramedics: A simulation study. Am J Emerg Med 2015; 33(8):1019-1024. Medline
III Neutral (Yellow) Time to ETI Patient SIM Szarpak L., Czyzewski L., Kurowski A. Comparison of the pentax, truview, GlideScope, and the miller laryngoscope for child intubation during resuscitation. Am J Emerg Med 2015; 33(3):391-395. Medline
III Neutral (Yellow) Time to ETI Patient SIM Szarpak L., Czyzewski L., Truszewski Z., Kurowski A. Pentax airway scope AWS-S200 video laryngoscope for child tracheal intubation in a manikin study with 3 airway scenarios. Am J Emerg Med 2015; 33(9):1171-1174. Medline
III Opposes (Red) ETI success Process SIM Fonte M., Oulego-Erroz I., Nadkarni L., Sanchez-Santos L., et al. A randomized comparison of the Glidescope video laryngoscope to the standard laryngoscopy for intubation by pediatric residents in simulated easy and difficult infant airway scenarios. Pediatr Emerg Care 2011; 27(5):398-402. Medline


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