ABSTRACTS
Association Between Prehospital Invasive and Non-Invasive Airway Management of Pediatric Trauma Patients.Author: Jackelyn Strange EMT-P | Paramedic | Sonoma County EMS, Sonoma State University Associate Authors: Pell, Lilikoi, B., B.S., EMT-B | Melfi, Teresa, V., EMT-B | Ahmad, Bill, A., EMT-B | Cline, Joseph, B.S., EMT-B | Jarvis, Jeffrey, L., MD, M.S., EMT-P | Fernandez, Antonio, R., PhD, NRP
Background Options for prehospital airway management of pediatric patients with traumatic injuries includes bag-valve mask ventilation alone (BVM) or in conjunction with invasive airway management (IAM) including endotracheal intubation (ETI) or supraglottic airways (SGA). Recent evidence-based guidelines for prehospital airway management identified a need for additional evidence to inform airway management practice in this population. Objective We sought to identify the association between prehospital BVM vs IAM and hospital survival among pediatric trauma patients. Methods We conducted a retrospective cohort study using the 2021-2023 ESO Data Collaborative including 911 responses to patients <15 of age with traumatic injury who received ventilatory support with a BVM. We excluded records without hospital outcome data. We then stratified patients by those who received bag-valve mask ventilations only and those that also received an invasive airway. We determined descriptive statistics of patients and incidents. Using multivariable logistic regression, adjusting for age, initial vital signs, transport time, and EMS witnessed cardiac arrest, adjusting for clustering by agency, we calculated odds ratios and 95% confidence intervals for the association between airway management approach and survival to hospital admission and discharge. Results A total of 1,011 patients met inclusion criteria. Of these, the median (IQR) age was 10(3-14), 665 (65.9%) were male, and the median (IQR) initial GCS was 3 (3-7). Overall survival was 53.4%. 517 (51.1%) received management with BVM alone vs 494 (48.9%) with IAM. Survival to discharge was 73.7-%with BVM alone versus 37.1% with IAM. There was no statistically significant relationship found between survival to discharge and BVM (compared to IAM) aOR 13.7; (95%CI: 0.9 - 207.4). Conclusion We found no association between pediatric trauma patients receiving airway management with BVM alone compared to BVM plus invasive airway using a large national dataset. Further work is needed to further investigate this important patient population.
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