Contemporary issues in pediatric prehospital airway management.

Introduction: Airway management is one of the most important interventions performed by paramedics in the prehospital setting. While the standard of care for over 40 years, multiple studies highlight pitfalls associated with prehospital airway management in adults. Considerably less research describes prehospital airway management in children.

Areas covered: We searched PubMed for articles from 2000 to present using the keywords 'children,' 'airway management,' 'intubation intratracheal,' 'Emergency Medical Services,' and 'paramedic.' Studies highlight the pitfalls of adult prehospital endotracheal intubation such as tube misplacement and dislodgement, multiple and failed insertion attempts, interruptions in chest compressions, and inadvertent hyperventilation. Multicenter clinical trials including the PART and Airways-2 trials support the use of newer supraglottic airways as potential alternatives to intubation in adults. Only limited data describe prehospital airway management in children, including only one clinical trial performed 25 years ago.

Expert opinion: New studies are needed to guide paramedic pediatric airway management practices. The Pediatric Prehospital Airway Resuscitation Trial (Pedi-PART) is an ongoing multicenter clinical trial that will provide critical new knowledge to guide prehospital pediatric airway management practices.