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Abstract
Objectives. Pediatric cardiac arrest patients andadult traumatic arrest patients are perceived as more difficult to endotracheally intubate than adult cardiac arrest patients. The study hypothesis was that these populations were at higher risk of endotracheal intubation failure compared with adult cardiac arrest patients andthat paramedics would more frequently defer attempts to intubate these patients. Methods. This was a retrospective, observational study analyzing oral endotracheal intubations on pediatric cardiac arrest, adult traumatic arrest, andadult cardiac arrest patients over 66 months. Homogeneity of intubation nonattempt andendotracheal intubation failure was studied with chi-square analysis. Relative risks (RRs) with 95% confidence intervals (CIs) were used to compare pediatric cardiac arrest with adult traumatic arrest with adult cardiac arrest nonattempt rates andendotracheal intubation failure rates. Results. 2,669 oral endotracheal intubations were included. There was a significant difference in intubation nonattempts andintubation failure between the combined pediatric cardiac arrest andadult traumatic arrest groups andthe adult cardiac arrest cohort (RR 7.24, 95% CI 5.73, 9.16 for nonattempt; RR = 2.33, 95% CI 1.93, 2.83 for intubation failure). Both groups individually showed significant risk for intubation nonattempt andendotracheal intubation failure compared with adult cardiac arrest, with the pediatric cohort at higher risk for failure andthe adult traumatic arrest cohort at higher risk for nonattempt. Conclusions. There was significant risk of intubation nonattempt andintubation failure in the pediatric cardiac arrest andadult traumatic arrest cohorts compared with the adult cardiac arrest population, with the pediatric cohort being at particularly high risk for intubation failure andthe adult traumatic arrest cohort at higher risk for nonattempt.