O3318: Optimizing Intubation Success in Transported Neonates and Pediatric Patients: Outcomes of a Phased Intervention Strategy

Background: First attempt intubation success is critical in neonatal and pediatric transport, as repeated attempts increase the risk of adverse outcomes. The Angel One Transport Team implemented targeted interventions to improve first attempt intubation success rates during interfacility transport. These included the introduction of video laryngoscopy in 2015, rapid sequence intubation (RSI) for neonatal intubations in 2018, and video laryngoscopy use for very low birth weight premature neonates in 2023. We hypothesized that the institution of these targeted interventions would improve first attempt intubation success rates. Our objective was to evaluate the impact of phased interventions on first attempt intubation success in neonatal and pediatric transport patients.

Methods: A comprehensive review of the transport team’s intubation database from January 2008 to April 2024 was conducted. Multiple new team members were added in April 2024, due to the opening of a new, remote transport base. These team members participated in supervised intubations, potentially skewing results after April 2024. Patients were categorized as pediatric (PP), neonates >1kg, and neonates < 1kg. First-attempt success rates were assessed before and after each intervention. Chi-square test was used for comparisons. P< 0.05 was considered statistically significant; 95% confidence intervals are included in parentheses.

Results: First-attempt intubation success was significantly higher in pediatric patients (PP) and neonatal patients (NP) >1kg compared to neonatal patients < 1kg, with rates of 64.60% (PP, N=226) and 59.13% (>1kg, N=619), versus 41.92% ( < 1kg, N=198), p< 0.0001. Video laryngoscopy improved success rates for pediatric patients and neonatal patients >1kg: PP 58.33% (pre-intervention, N=108) versus 73.72% (post-intervention, N=118), 15.39%diff (3.05%,27.19%), p=0.01. NP >1kg, 47.52% (pre-intervention, N=242) versus 64.19% (post-intervention, N=377), 16.67%diff (8.67%,24.44%), p< 0.0001. Introduction of an RSI protocol for neonates >1kg led to improved first attempt intubation success: 51.92% (pre-intervention, N=364) versus 65.88% (post-intervention, N=255), 13.96%diff (6.08%,21.51%), p=0.005. In April 2023, video laryngoscopy was introduced for neonatal patients < 1kg: 41.30% (pre-intervention, N=184) versus 50.0% (post-intervention, N=14), -8.7%diff (-15.60%,32.90%), p=0.53. A projected sample size of 405 neonates in the post-intervention group would be required to confirm statistical significance at the observed post-intervention success rate.

Conclusion: Phased implementation of targeted interventions improved first-attempt intubation success rates for pediatric and neonatal patients >1kg. Video laryngoscopy for neonatal patients < 1kg showed improved first attempt intubation rates that were not statistically significant. Further methods of intubation improvement should be investigated, especially low birth weight premature infants.