Impact of Difficult Laryngoscopy on First-Pass Success and Adverse Events in Pediatric Emergency Department Intubations.

IF 1.6 4区医学 Q2 ANESTHESIOLOGY

Pediatric Anesthesia Pub Date : 2026-09-01 Epub Date: 2026-06-16 DOI:10.1002/pan.70242

Tom Solan, Stefan Sabato, Hatem Alkhouri, Michael Dinh, Katie Reeves, Andrew Tagg, Nathan Forsyth, Bernard McCarthy, Eleanor Loughhead, Ben Lawton, Matthew Gorman, Jeremy Furyk, Frances Kinnear, Andrew Brainard, Meredith L Borland, Shane George, Amit Kochar, Simon Craig, Franz E Babl, Elliot Long

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引用次数: 0

Abstract

Background: Airway management in the Emergency Department (ED) can be challenging, particularly in children. Difficult laryngoscopy reduces first-pass success and increases complications, but pediatric ED data remain limited.

Methods: We conducted a prospective, observational study of pediatric intubations recorded in the Australian and New Zealand Emergency Department Airway Registry (ANZEDAR) between 2012 and 2025, including 25 Pediatric Research in Emergency Departments International Collaborative (PREDICT) sites. The primary outcome was the incidence of difficult laryngoscopy. Secondary outcomes were the impact of difficult laryngoscopy on First-Pass Success (FPS) and adverse events. The main exposure variable was laryngoscopic grade, defined as difficult when a Cormack-Lehane Grade 3 or 4 view was encountered on the first attempt. Patient, procedural, and operator characteristics were assessed as potential confounders.

Results: Of 946 pediatric ED intubations recorded across 55 sites (including 25 PREDICT pediatric sites) between 2012 and 2025, 865 were included in the analysis after exclusion of cases with missing laryngoscopic grade. The median age was 3.5 years. Difficult laryngoscopy (Cormack-Lehane grade 3-4) was observed in 65 cases (7.5%). FPS was significantly lower in patients with a difficult view compared with those with a non-difficult view (41.5% vs. 87.9%; OR 0.10, 95% CI 0.06-0.17). Adverse events were more frequent in the difficult-view group, including hypoxaemia (38.5% vs. 11.5%; OR 4.81, 95% CI 2.79-8.29) and esophageal intubation (15.4% vs. 1.3%; OR 14.36, 95% CI 5.73-35.98).

Conclusion: Difficult laryngoscopy in pediatric ED intubations is relatively infrequent but associated with reduced FPS and increased complications. These findings emphasize the importance of ongoing quality improvement and may help inform training and escalation strategies. Continued registry participation is valuable to capture these low-frequency events and better understand their consequences.

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困难喉镜检查对儿科急诊科插管首次成功和不良事件的影响。

背景：急诊科（ED）的气道管理具有挑战性，尤其是儿童。困难的喉镜检查降低了首次通过的成功率并增加了并发症，但儿科急诊科的数据仍然有限。方法：我们对2012年至2025年间澳大利亚和新西兰急诊科气道登记处（ANZEDAR）记录的儿科插管进行了一项前瞻性观察性研究，其中包括25个急诊科国际合作（PREDICT）站点的儿科研究。主要结局是喉镜检查困难的发生率。次要结局是困难喉镜检查对首次通过成功率（FPS）和不良事件的影响。主要的暴露变量是喉镜分级，当第一次尝试时遇到Cormack-Lehane 3级或4级视图时定义为困难。评估患者、程序和操作人员的特征作为潜在的混杂因素。结果：在2012年至2025年期间，在55个地点（包括25个PREDICT儿科地点）记录的946例儿科ED插管中，在排除喉镜分级缺失的病例后，865例被纳入分析。中位年龄为3.5岁。65例（7.5%）喉镜检查困难（Cormack-Lehane 3-4级）。视野困难的患者FPS明显低于视野非困难的患者（41.5% vs. 87.9%; OR 0.10, 95% CI 0.06-0.17）。不良事件在困难视点组更为频繁，包括低氧血症（38.5%比11.5%;OR 4.81, 95% CI 2.79-8.29）和食管插管（15.4%比1.3%;OR 14.36, 95% CI 5.73-35.98）。结论：困难喉镜检查在儿童ED插管中相对少见，但与FPS降低和并发症增加有关。这些发现强调了持续质量改进的重要性，并可能有助于为培训和升级战略提供信息。持续的注册中心参与对于捕获这些低频率事件并更好地理解其后果是有价值的。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Pediatric Anesthesia 医学-麻醉学

CiteScore

3.20

自引率

11.80%

发文量

222

审稿时长

3-8 weeks

期刊介绍： Devoted to the dissemination of research of interest and importance to practising anesthetists everywhere, the scientific and clinical content of Pediatric Anesthesia covers a wide selection of medical disciplines in all areas relevant to paediatric anaesthesia, pain management and peri-operative medicine. The International Editorial Board is supported by the Editorial Advisory Board and a team of Senior Advisors, to ensure that the journal is publishing the best work from the front line of research in the field. The journal publishes high-quality, relevant scientific and clinical research papers, reviews, commentaries, pro-con debates, historical vignettes, correspondence, case presentations and book reviews.