363 - A Comparison Between Pediatric Emergency Fellows and Emergency Medicine Residents Of Success During Tracheal Intubation: A Report From the Videography In Pediatric Resuscitation (VIPER) Collaborative)

Poster Number: 363
Publication Number: 363.211

Aaron Donoghue, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, United States; Karen O'Connell, Children's National Health System, Washington, DC, United States; Tara Neubrand, University of New Mexico, Albuquerque, NM, United States; Sage R. Myers, Children’s Hospital of Philadelphia, Philadelphia, PA, United States; Benjamin Kerrey, Cincinnati Children's Medical Center, Cincinnati, OH, United States

Background:

Tracheal intubation (TI) in the pediatric emergency department (PED) is a fundamental procedure but uncommonly performed by individual providers.  PEDs have to balance the training needs of PEM fellows and EM residents in critical procedures, including TI, while ensuring patient safety and optimal care.

Objective:

To determine the association between trainee background (PEM fellow versus EM resident) and clinical outcomes from TI in the PED.

Design/Methods:

This study was a secondary analysis of data collected by the Videography In Pediatric Resuscitation (VIPER) Collaborative.  From 4 PEDs, all patient encounters with their first TI attempts by a PEM fellow or an EM resident were eligible.  Data were collected by structured video review. The main outcome was first attempt success, compared between PEM fellows and EM residents. We also examined attempt duration and oxyhemoglobin desaturation between groups. We performed multivariable analyses of first attempt success with several candidate covariates, with site as a random effect.

Results:

218 first TI attempts were analyzed: 160 (73%) by PEM fellows and 58 (27%) by EM residents.  Overall first attempt success was 137/218 (63%), and median attempt duration was 37 s (IQR 26 – 55 s). Oxyhemoglobin desaturation occurred in 39 of 195 (20%) patients with data available.  First attempt success was more common for EM residents than PEM fellows (78% vs. 58%, p=0.007). First attempt success was also lower in infants versus older children (47% vs. 68%, p< 0.001).  There were no other significant differences in first attempt success for any covariate.  On multivariate analysis, EM residents had an independent association with first attempt success (AOR 1.20, 95% CI 1.05 – 1.39).  There were no differences in attempt duration or incidence of desaturation between groups. 
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 < ![if !supportAnnotations] >[KB(1]< ![endif] >Did this adjust only for site and patient age?
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Conclusion(s):

In a collaborative of four PEDs, EM residents had greater first attempt TI success than PEM fellows, after adjusting for effects of site and patient age.  These considerations should be taken into account in PEDs when determining the best choice of intubator to optimize trainee experience as well as patient safety.