Documented Oxygen Saturation in Pediatric Patients Undergoing Prehospital Advanced Airway Placement

Prehospital pediatric advanced airway management, which involves the use of a supraglottic airway (SGA) or endotracheal intubation (ETI), is a rare but critical skill for prehospital clinicians. Pre- and post-airway assessment and documentation of oxygen saturation (SpO2) is essential to ensuring the best outcomes and to minimize the risk of adverse events. We aimed to study how often prehospital clinicians document SpO2 when placing an advanced airway in non-arrest pediatric patients.

Using the 2022-2024 ESO Data Collaborative, we identified 9-1-1 scene responses to children ages 2 to 17 years in which EMS placed either an endotracheal tube (ETT) or supraglottic airway (SGA). We excluded children in cardiac arrest at the time of airway placement, and limited the analysis to the initial airway attempt, whether successful or not. Consistent with National EMS Quality Alliance (NEMSQA) guidelines, we determined the frequency of oxygen saturation (SpO2) documentation in the three minutes before and five minutes after the first ETT/SGA attempt; we also determined the frequency of SpO2 documentation at any time prior to or after the ETT/SGA attempt. We present the results as proportions with 95% confidence intervals.

Among 1,414 children with non-arrest pediatric airway interventions, 636 (45%, CI 42%-48%) had SpO2 documented in the three minutes before the ETT/SGA attempt and 937 (66%, CI 64%-69%) had SpO2 documented in the five minutes after the attempt. SpO2 was documented in both periods for 508 (36%, CI: 33%-39%) ETT/SGA attempts. There were 1,019 (72%, CI 70%-74%) patients who had at least one SpO2 documented at any time pre-attempt, and 1,102 (78%, CI: 76%-80%) patients who had at least one post-attempt SpO2 documented. There were 185 (13%, CI 11%-15%) ETT/SGA attempts with no documented pre- or post-attempt SpO2.

A minority of non-arrest pediatric patients undergoing prehospital advanced airway placement have an SpO2 documented in both the three minutes before and five minutes after the airway intervention. These findings highlight the need for heightened quality improvement efforts focused on adherence to safe clinical practice standards in EMS systems that allow advanced airway placement in non-arrest pediatric patients.