Abstract
Background
Airway management procedures are critical for emergency medicine (EM) physicians,
but rarely performed skills in pediatric patients. Worldwide experience with respect
to frequency and confidence in performing airway management skills has not been previously
described.
Objectives
Our aims were 1) to determine the frequency with which emergency medicine physicians
perform airway procedures including: bag-mask ventilation (BMV), endotracheal intubation
(ETI), laryngeal mask airway (LMA) insertion, tracheostomy tube change (TTC), and
surgical airways, and 2) to investigate predictors of procedural confidence regarding
advanced airway management in children.
Methods
A web-based survey of senior emergency physicians was distributed through the six
research networks associated with Pediatric Emergency Research Network (PERN). Senior
physician was defined as anyone working without direct supervision at any point in
a 24-h cycle. Physicians were queried regarding their most recent clinical experience
performing or supervising airway procedures, as well as with hands on practice time
or procedural teaching. Reponses were dichotomized to within the last year, or ≥ 1 year.
Confidence was assessed using a Likert scale for each procedure, with results for
ETI and LMA stratified by age. Response levels were dichotomized to “not confident”
or “confident.” Multivariate regression models were used to assess relevant associations.
Results
1602 of 2446 (65%) eligible clinicians at 96 PERN sites responded. In the previous
year, 1297 (85%) physicians reported having performed bag-mask ventilation, 900 (59%)
had performed intubation, 248 (17%) had placed a laryngeal mask airway, 348 (23%)
had changed a tracheostomy tube, and 18 (1%) had performed a surgical airway. Of respondents,
13% of physicians reported the opportunity to supervise but not provide ETI, 5% for
LMA and 5% for BMV. The percentage of physicians reporting “confidence” in performing
each procedure was: BMV (95%) TTC (43%), and surgical airway (16%). Clinician confidence
in ETT and LMA varied by patient age. Supervision of an airway procedure was the strongest
predictor of procedural confidence across airway procedures.
Conclusion
BMV and ETI were the most commonly performed pediatric airway procedures by emergency
medicine physicians, and surgical airways are very infrequent. Supervising airway
procedures may serve to maintain procedural confidence for physicians despite infrequent
opportunities as the primary proceduralist.
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Article Info
Publication History
Published online: December 30, 2020
Accepted:
December 27,
2020
Received in revised form:
December 22,
2020
Received:
September 15,
2020
Identification
Copyright
© 2020 Elsevier Inc. All rights reserved.
