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Pediatric airway options

Question# 676

Given that the success rate for intubations in the pediatric populations is low, the infrequency at which these skills are performed, coupled with the stress induced by such calls I am curious what RPPEO's position is on SGA's like the i-gel specifically for the pediatric population.

Answer:

Thank you for your inquiry. We appreciate that pediatric emergencies can be very dynamic. We have posed your question to Dr Piscopo, Base Hospital Physician and pediatric specialist with the Children’s Hospital of Eastern Ontario
She offers the following thoughts on the topic, complete with resources;

“BVM has the best survival outcomes among all airway support techniques among children. Compared to intubation, SGA shows some evidence of improved outcomes as well. We will not be removing the pediatric intubation among the skills due to the occasional cases where this will be the airway of choice (such as impending upper airway obstruction). Please see the below articles that support this point of view. In summary airway technical support of choice: BVM > SGA > ETT
https://pubmed.ncbi.nlm.nih.gov/10683058/

“These results indicate that the addition of out-of-hospital ETI to a paramedic scope of practice that already includes BVM did not improve survival or neurological outcome of pediatric patients treated in an urban EMS system.”
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5660668/

Did not directly compare ETI to SGA but when looking individually at the percentages, SGA outperformed ETI for rates of sustained ROSC, survival to hospital discharge”

Medical Directive Category

Airway

Published

31 March 2023

Views

459

Please reference the MOST RECENT ALS PCS for updates and changes to these directives.