High-risk criteria for the physiologically difficult paediatric airway: A multicenter, observational study to generate validity evidence

Dean, P; Geis, G; Hoehn, EF; Lautz, AJ; Edmunds, K; Shah, A; Zhang, Y; Frey, M; Boyd, S; Nagler, J; Miller, KA; Neubrand, TL; Cabrera, N; Kopp, TM; Wadih, E; Kannikeswaran, N; VanDeWall, A; Hewett Brumberg, EK; Donoghue, A; Palladino, L; O'Connell, KJ; Mazzawi, M; Tam, DCF; Murray, M; Kerrey, B

doi:10.1016/j.resuscitation.2023.109875

Pediatric anesthesia & critical care

High-risk criteria for the physiologically difficult paediatric airway: A multicenter, observational study to generate validity evidence

ResuscitationPublished 14 Jun 2023Retrospective cohort study

Main finding · Peri-intubation cardiac arrestResultAdjusted odds ratio 75.7 95% CI 9.7–592.6

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Authors' conclusion

In a multicenter study, we confirmed that meeting at least one high-risk criterion was associated with paediatric peri-intubation cardiac arrest and patient mortality.

Study context

Population: Paediatric patients undergoing tracheal intubation in academic paediatric emergency department (EDs)150 per ED
Participants: 1,200 patients

Exposure: ≥1 high-risk criterion vs no high-risk criteria
≥1 high-risk criterionn = 332
Outcome: Peri-intubation cardiac arrest

Methodological detailsmulticentre, 8 academic paediatric EDs

Multicentre
8 academic paediatric EDs

Main finding

As reported in the abstract

Adjusted odds ratio

75.7

95% CI 9.7–592.6

≥1 high-risk criterion vs No high-risk criteria

AOR 75.7 (95% CI 9.7–592.6)

Observational data: associations, not effects.

Secondary outcomes

Outcome	← Lower odds with ≥1 high-risk criterion ←→ Higher odds with ≥1 high-risk criterion →	AOR (95% CI)
ECMO cannulation	0.050.21520	7.1 (2.3–22.3)
In-hospital mortality	0.050.21520	3.4 (1.9–6.2)
	0.050.21520Adjusted odds ratio (log scale)

Parts of this Brief are withheld: the automatic checks could not confirm them against the abstract.

Reference

Authors: Dean P, Geis G, Hoehn EF, Lautz AJ, Edmunds K, Shah A, et al.
All 25 authors
Dean P, Geis G, Hoehn EF, Lautz AJ, Edmunds K, Shah A, Zhang Y, Frey M, Boyd S, Nagler J, Miller KA, Neubrand TL, Cabrera N, Kopp TM, Wadih E, Kannikeswaran N, VanDeWall A, Hewett Brumberg EK, Donoghue A, Palladino L, O'Connell KJ, Mazzawi M, Tam DCF, Murray M, Kerrey B
Journal: Resuscitation
Published: 14 Jun 2023
DOI: 10.1016/j.resuscitation.2023.109875
PubMed: 37327848

Topic: Pediatric anesthesia & critical care
Also indexed: Airway management

Exposure definitions

≥1 high-risk criterion: persistent hypoxemia despite supplemental oxygen, persistent hypotension, concern for cardiac dysfunction, post-ROSC, severe metabolic acidosis (pH < 7.1) or status asthmaticus

Key notes

4 of 6 criteria independently associated with peri-intubation arrest: persistent hypoxemia despite supplemental oxygen, persistent hypotension, concern for cardiac dysfunction, post-ROSC
Adjusted analysis

Original publication

High-risk criteria for the physiologically difficult paediatric airway: A multicenter, observational study to generate validity evidence. Resuscitation. Published 14 June 2023. doi:10.1016/j.resuscitation.2023.109875

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