This is an observational study of pediatric medical resuscitation, published in Annals of Emergency Medicine, using video to evaluate the frequency of various adverse events during pediatric intubation.
As expected in a teaching institution, there is a fair bit of variability in initial success rates – ranging from 35% first-pass success for pediatrics residents up to 89% for PEM or anesthesia attendings. Overall 52% had success on the first attempt. Unfortunately, 61% experienced at least one adverse event during intubation. These were typically not clinically important with regard to patient-oriented outcomes.
However, what is more entertainingly concerning is how few of the complications make it into the medical record. The written documentation overestimates first-attempt success, underestimates desaturation during the procedure, and even completely omits any mention of one of the two episodes of CPR required during resuscitation.
My guess is that Cincinnati Children’s may have had a documentation quality review after this data were collected.
“Rapid Sequence Intubation for Pediatric Emergency Patients: Higher Frequency of Failed Attempts and Adverse Effects Found by Video Review”
www.ncbi.nlm.nih.gov/pubmed/22424653