Evaluation of Prehospital Endotracheal Intubation in Pediatric Patients in a German Helicopter Emergency Medical Service: An Analysis of 920 Cases.

Management of the pediatric airway is a challenging procedure in prehospital emergency medicine. This retrospective study evaluates prehospital airway management in 920 pediatric patients in a German helicopter emergency medical service (HEMS) system from 2012 to 2021. Prehospital pediatric intubation was a rare event (0.2% of all missions). Good visualization of the glottis (Cormack-Lehane I or II) was possible in 96.3% of the intubations. The first-pass intubation success was 86.6%; all children could finally be intubated successfully. The use of muscle relaxants significantly improved first-pass success in prehospital emergency anesthesia (90.1% vs. 83.1%; P = .002). We recognized a low rate of the use of aids such as stylet, bougie, or video laryngoscopy. The use of video laryngoscopy increased over the years, but did not translate into a higher first-attempt success rate. When taking over children with an already managed airway, HEMS teams found tube malplacement in 8.4% of the cases in primary missions. In the analyzed data, pediatric airway management was on a comparable level with adult airway management. Nevertheless, room for improvement and a need for further studies were identified.