Pediatric anesthesia & critical care
Impact of Difficult Laryngoscopy on First‐Pass Success and Adverse Events in Pediatric Emergency Department Intubations
Authors' conclusion
Difficult laryngoscopy in pediatric ED intubations is relatively infrequent but associated with reduced FPS and increased complications.
Study context
- Population
- Pediatric Emergency Department (ED) intubations, and New Zealand Emergency Department Airway Registry (ANZEDAR), 55 sites (incl. 25 Pediatric Research in Emergency Departments International Collaborative (PREDICT) sites), 2012–2025865 analysed
- Participants
- 946 participants
- Exposure
- Difficult vs non-difficult laryngoscopic view on first attempt
- Difficult viewn = 65
- Outcome
- Incidence of difficult laryngoscopy (Cormack-Lehane grade 3-4)
Methodological detailsmulticentre registry
- Multicentre registry
Main finding
As reported in the abstract
Incidence of difficult laryngoscopy (Cormack-Lehane grade 3-4 on first attempt)
Difficult laryngoscopy (Cormack-Lehane grade 3-4) observed
65 cases
7.5%
Observational data: associations, not effects.
Secondary outcomes
| Outcome | Difficult view | Non-difficult view | Estimate | |
|---|---|---|---|---|
| First-pass success (FPS)FPS significantly lower with difficult view | 41.5% | 87.9% | OR for first-pass success 0.10 (95% CI 0.06–0.17) | |
| Hypoxaemia (adverse event) | 38.5% | 11.5% | OR for hypoxaemia 4.81 (95% CI 2.79–8.29) | |
| Esophageal intubation (adverse event) | 15.4% | 1.3% | OR for esophageal intubation 14.36 (95% CI 5.73–35.98) | |
| 0.050.21520Ratio (log scale) |
Safety
| Outcome | Difficult view | Non-difficult view | OR (95% CI) | |
|---|---|---|---|---|
| Hypoxaemia | 38.5% | 11.5% | 4.81 (2.79–8.29) | |
| Esophageal intubation | 15.4% | 1.3% | 14.36 (5.73–35.98) | |
| 0.050.21520Odds ratio (log scale) |
Original publication
Impact of Difficult Laryngoscopy on First‐Pass Success and Adverse Events in Pediatric Emergency Department Intubations. Paediatr Anaesth. Published 16 June 2026. doi:10.
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