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Adverse events and risk factors during emergency intubation in a tertiary paediatric emergency department

Löllgen, Ruth, M.C.a,b,*; Pontin, Jennifera,*; Gow, Matthewa; McCaskill, Mary, E.a

European Journal of Emergency Medicine: June 2018 - Volume 25 - Issue 3 - p 209–215
doi: 10.1097/MEJ.0000000000000439

Background Rapid sequence intubation and emergency intubation in the emergency department (ED) can be life-saving procedures, but require the appropriate skills, experience and preparation to avoid complications ranging from simple trauma to life-threatening desaturation. Only scarce data exist in the published literature on complications following emergency intubation in children and most guidelines are extrapolated from the adult population.

Patients and methods We reviewed all emergency intubations of patients in our tertiary paediatric ED within a 2-year period to estimate the incidence of complications and to analyse the risk factors associated with this procedure.

Results Seventy-two children were intubated; complications occurred in one in four and repeated attempts at intubation in 17/23 children. The median age of the children was 2 years (range: 0 days–6 years). The most common reason for intubation was altered level of consciousness and the most frequent diagnosis at the time of intubation was seizure/status epilepticus. Complications were related to desaturation (n=7), equipment failure (n=3), intravenous access (n=2) and hypotension (n=2), erroneous or insufficient drug preparation (n=1) and other reasons (n=3). There was no significant association of complications with the child’s age or weight, time of arrival to ED, preintubation hypotension or combination of drugs used.

Conclusion Complications of rapid sequence intubation, a relatively low-frequency procedure in the paediatric ED, occurred in one of four children and repeat attempts at intubation were made in another 24%. We suggest that the use of an intubation checklist including the preparation of equipment and recommendations for drug use would minimize the occurrence of adverse events of intubation in children.

aEmergency Department, The Children’s Hospital at Westmead, Westmead, New South Wales, Australia

bPaediatric Emergency Department, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland

* Ruth Mari Löllgen and Jennifer Pontin contributed equally to the writing of this article.

Correspondence to Ruth M.C. Löllgen, MD, Paediatric Emergency Department, Inselspital, Bern University Hospital, University of Bern, Bern 3010, Switzerland Tel: +41 76 200 2701; fax: +41 31 632 8408; e-mail:

Received March 17, 2016

Accepted November 24, 2016

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