Supraglottic Airway Device Use During Paediatric Airway Management in the Emergency Department: A Registry Study

Abstract

BACKGROUND: Supraglottic airway devices (SGAs) are used in airway management to provide non-invasive ventilation and oxygenation. SGAs can be used as rescue tools in failed endotracheal intubation, difficult bag-mask ventilation, or as a bridge to intubation in cardiac arrest. OBJECTIVES: The aim of this study was to describe the frequency of SGA use in children in emergency departments (EDs) across Australia and New Zealand and indications for their use. METHODS: We conducted a retrospective observational study using paediatric data from the Australian and New Zealand Emergency Department Airway Registry (ANZEDAR) to describe the frequency of SGA use in children aged 0-18 years at Paediatric Research in Emergency Departments International Collaborative (PREDICT) sites over an 11-year period. Additionally, we surveyed 20 PREDICT sites to identify which SGA were used and describe their positions in their emergency airway management protocols and received 11 responses. RESULTS: SGAs were used during 14 out of 403 paediatric intubations (3.5%) across 12 PREDICT sites. The overall first pass success rate for intubation was 81.05% (325/401). SGAs were used prior to intubation in 14 cases, and as a rescue device following unsuccessful intubation in one case. Among the surveyed PREDICT EDs, 8 out of 11 (72%) reported having a difficult airway plan that included SGAs as a rescue device following unsuccessful intubation. CONCLUSIONS: SGAs were used infrequently during emergency airway management outside of the operating room. SGA use as a rescue device following unsuccessful intubation was rare, despite their inclusion in most departments' difficult airway plan. TRIAL REGISTRATION: Australia and New Zealand Clinical Trials Registry: ACTRN12613001052729.