The number of tracheal intubation attempts matters! A prospective multi-institutional pediatric observational study

Table 4 Description of tracheal intubation associated events

	1 attempt (n = 1256)	2 attempts (n = 503)	≥ 3 attempts (n = 321)
Severe TIAEs^a
Cardiac arrest with ROSC^b	12 (1.0 %)	8 (1.6 %)	11 (3.4 %)
Cardiac arrest without ROSC	3 (0.2 %)	4 (0.8 %)	1 (0.3 %)
Esophageal intubation without immediate recognition	2 (0.2 %)	5 (1.0 %)	5 (1.6 %)
Emesis with aspiration	5 (0.4 %)	6 (1.2 %)	16 (0.8 %)
Hypotension requiring treatment	42 (3.3 %)	20 (4.0 %)	7 (2.2 %)
Laryngospasm	1 (0.1 %)	1 (0.2 %)	2 (0.6 %)
Malignant hyperthermia	0 (0.0 %)	0 (0.0 %)	0 (0.0 %)
Pneumothorax/pneumomediastinum	2 (0.2 %)	0 (0.0 %)	2 (0.6 %)
Dental trauma	1 (0.1 %)	2 (0.4 %)	0 (0.0 %)
Non-severe TIAEs
Mainstem bronchial intubation	25 (2.0 %)	24 (4.8 %)	17 (5.3 %)
Esophageal intubation with immediate recognition	10 (0.8 %)	74 (14.7 %)	88 (27.4 %)
Emesis without aspiration	9 (0.7 %)	3 (0.6 %)	4 (1.3 %)
Dysrhythmia (includes sinus bradycardia)	10 (0.8 %)	15 (3.0 %)	9 (2.8 %)
Hypertension requiring treatment	1 (0.1 %)	2 (0.4 %)	0 (0.0 %)
Epistaxis	2 (0.2 %)	2 (0.4 %)	1 (0.3 %)
Lip trauma	1 (0.1 %)	3 (0.6 %)	5 (1.6 %)
Medication Error	1 (0.1 %)	0 (0.0 %)	1 (0.3 %)
Pain/Agitation requiring additional medication with delay in tracheal intubation	3 (0.2 %)	5 (1.0 %)	1 (0.3 %)

Note: If the patient had more than one course before successful intubation (e.g., switch from direct laryngoscopy approach to laryngeal mask airway), then only the first course was included for analysis. Therefore there were patients who had one attempt but still had an esophageal intubation
^aTIAEs denotes tracheal intubation associated events
^bROSC denotes return of spontaneous circulation

ISSN: 1471-2431