Meta-Analysis of failure of prehospital endotracheal intubation in pediatric patients
Prehospital care is essential for airway preservation in pediatric patients who require early endotracheal intubation to improve oxygenation and prevent aspiration. However, high frequencies of failure of endotracheal intubation have been reported for this age group. We aimed to analyze the frequenc...
- Autores:
-
Higuita Gutiérrez, Luis Felipe
Rodríguez, Jhon Jairo
Carrillo Garcia, Edwar Arturo
Castaño Betancur, Esneider
Luna Londoño, Mauricio
Restrepo Vargas, Sara
- Tipo de recurso:
- Article of journal
- Fecha de publicación:
- 2020
- Institución:
- Universidad Cooperativa de Colombia
- Repositorio:
- Repositorio UCC
- Idioma:
- OAI Identifier:
- oai:repository.ucc.edu.co:20.500.12494/28268
- Palabra clave:
- Intubation
Pediatric
Meta-Analysis
Intubation
Pediatric
Meta-Analysis
- Rights
- openAccess
- License
- Atribución
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Meta-Analysis of failure of prehospital endotracheal intubation in pediatric patients |
| title |
Meta-Analysis of failure of prehospital endotracheal intubation in pediatric patients |
| spellingShingle |
Meta-Analysis of failure of prehospital endotracheal intubation in pediatric patients Intubation Pediatric Meta-Analysis Intubation Pediatric Meta-Analysis |
| title_short |
Meta-Analysis of failure of prehospital endotracheal intubation in pediatric patients |
| title_full |
Meta-Analysis of failure of prehospital endotracheal intubation in pediatric patients |
| title_fullStr |
Meta-Analysis of failure of prehospital endotracheal intubation in pediatric patients |
| title_full_unstemmed |
Meta-Analysis of failure of prehospital endotracheal intubation in pediatric patients |
| title_sort |
Meta-Analysis of failure of prehospital endotracheal intubation in pediatric patients |
| dc.creator.fl_str_mv |
Higuita Gutiérrez, Luis Felipe Rodríguez, Jhon Jairo Carrillo Garcia, Edwar Arturo Castaño Betancur, Esneider Luna Londoño, Mauricio Restrepo Vargas, Sara |
| dc.contributor.author.none.fl_str_mv |
Higuita Gutiérrez, Luis Felipe Rodríguez, Jhon Jairo Carrillo Garcia, Edwar Arturo Castaño Betancur, Esneider Luna Londoño, Mauricio Restrepo Vargas, Sara |
| dc.subject.spa.fl_str_mv |
Intubation Pediatric Meta-Analysis |
| topic |
Intubation Pediatric Meta-Analysis Intubation Pediatric Meta-Analysis |
| dc.subject.other.spa.fl_str_mv |
Intubation Pediatric Meta-Analysis |
| description |
Prehospital care is essential for airway preservation in pediatric patients who require early endotracheal intubation to improve oxygenation and prevent aspiration. However, high frequencies of failure of endotracheal intubation have been reported for this age group. We aimed to analyze the frequency of failure of endotracheal intubation in pediatric patients within a prehospital context and compare it with adult patients. Thus, a systematic revision of literature with a meta-analysis was performed using a study search and selection strategy ensuring extensiveness, sensitivity, and reproducibility. Meta-analyses were performed for odds ratio, DerSimonian and Laird’s Q test was used to assess heterogeneity, and Egger and Begg’s test was used to assess publication bias. Overall, 17 papers and 8772 patients were included, and the main cause of prehospital care was assessed to be trauma. Failed endotracheal intubation frequency was 0.4%–52.6% in pediatric patients. The most frequent complication was with esophageal intubation. Forest plot suggests that risk of failure during intubation of pediatric patients is 3.54 fold higher than that observed for adults. It was concluded that airway management in pediatric patients within a prehospital context is a challenge for prehospital care providers because it entails clear physiological and anatomical differences and a low frequency of exposure to this kind of events as opposed to adults. These differences support a widely higher risk of failure of intubation, suggesting the necessity of consistently trained prehospital care providers to ensure proficiency in technique as well as availability of the required equipment. |
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2020 |
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2020-11-25T17:49:42Z |
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2020-11-25T17:49:42Z |
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2020-05-02 |
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Artículo |
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http://purl.org/coar/resource_type/c_2df8fbb1 |
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http://purl.org/coar/resource_type/c_6501 |
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http://purl.org/coar/version/c_970fb48d4fbd8a85 |
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20902840 |
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https://doi.org/10.1155/2020/7012508 |
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https://hdl.handle.net/20.500.12494/28268 |
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Rodríguez, J. J., Higuita-Gutiérrez, L. F., Carrillo García, E. A., Castaño Betancur, E., Luna Londoño, M., & Restrepo Vargas, S. (2020). Meta-Analysis of Failure of Prehospital Endotracheal Intubation in Pediatric Patients. Emergency medicine international, 2020, 7012508. https://doi.org/10.1155/2020/7012508 |
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20902840 Rodríguez, J. J., Higuita-Gutiérrez, L. F., Carrillo García, E. A., Castaño Betancur, E., Luna Londoño, M., & Restrepo Vargas, S. (2020). Meta-Analysis of Failure of Prehospital Endotracheal Intubation in Pediatric Patients. Emergency medicine international, 2020, 7012508. https://doi.org/10.1155/2020/7012508 |
| url |
https://doi.org/10.1155/2020/7012508 https://hdl.handle.net/20.500.12494/28268 |
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https://www.hindawi.com/journals/emi/2020/7012508/ |
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Emergency Medicine International |
| dc.relation.references.spa.fl_str_mv |
A. Thind, R. Hsia, J. Mabweijano, E. R. Hicks, A. Zakariah, and C. N. Mock, “Prehospital and emergency care,” in Essential Surgery: Disease Control Priorities, vol. 1, pp. 245–262, World Bank, Washington, DC, USA, 3rd edition, 2015. A. Mehmood, A. Rowther, O. Kobusingye, and A. Hyder, “Assessment of pre-hospital emergency medical services in low-income settings using a health systems approach,” International Journal of Emergency Medicine, vol. 11, pp. 53–63, 2018. J. L. Arnold, “International emergency medicine and the recent development of emergency medicine worldwide,” Annals of Emergency Medicine, vol. 33, no. 1, pp. 97–103, 1999. A. M. K. Harmsen, G. F. Giannakopoulos, P. R. Moerbeek, E. P. Jansma, H. J. Bonjer, and F. W. Bloemers, “The influence of prehospital time on trauma patients outcome: a systematic review,” Injury, vol. 46, no. 4, pp. 602–609, 2015. F. Jewkes, “Current topic: prehospital emergency care for children,” Archives of Disease in Childhood, vol. 84, no. 2, pp. 103–105, 2001. H. H. Kyu, C. E. Stein, C. Boschi Pinto et al., “Causes of death among children aged 5-14 years in the WHO European Region: a systematic analysis for the Global Burden of Disease Study 2016,” The Lancet Child & Adolescent Health, vol. 2, no. 5, pp. 321–337, 2018. R. J. Winchell and D. Hoyt, “Endotracheal intubation in the field improves survival in patients with severe head injury,” Archives of Surgery, vol. 132, no. 6, pp. 592–597, 1997. J. G. Hardman and J. S. Wills, “The development of hypoxaemia during apnoea in children: a computational modelling investigation,” British Journal of Anaesthesia, vol. 97, no. 4, pp. 564–570, 2006. P. E. Sirbaugh, P. E. Pepe, J. E. Shook et al., “A prospective, population-based study of the demographics, epidemiology, management, and outcome of out-of-hospital pediatric cardiopulmonary arrest,” Annals of Emergency Medicine, vol. 33, no. 2, pp. 174–184, 1999. T. B. Borja, M. E. Cruz, M. M. Medina, and G. E. Benitez, “Atención prehospitalaria del niño accidentado grave,” Journal of the Mexican Association of Critical Medicine and Intensive Therapy, vol. 16, pp. 185–200, 2002. P. F. Ehrlich, P. S. Seidman, O. Atallah, A. Haque, and J. Helmkamp, “Endotracheal intubations in rural pediatric trauma patients,” Journal of Pediatric Surgery, vol. 39, no. 9, pp. 1376–1380, 2004. P. C. Echeverry Marín and T. Engelhardt, “Algoritmo para el manejo de la vía aérea difícil en pediatría,” Revista Colombiana de Anestesiología, vol. 42, no. 4, pp. 325–334, 2014. N. Jagannathan, L. Sohn, and J. Fiadjoe, “Paediatric difficult airway management: what every anaesthetist should know!,” British Journal of Anaesthesia, vol. 117, pp. i3–i5, 2016. J. B. Orenstein, “Prehospital pediatric airway management,” Clinical Pediatric Emergency Medicine, vol. 7, no. 1, pp. 31–37, 2006. M. Hansen, G. Meckler, K. OʼBrien et al., “Pediatric airway management and prehospital patient safety,” Pediatric Emergency Care, vol. 32, no. 9, pp. 603–607, 2016. S. Heschl, B. Meadley, E. Andrew, W. Butt, S. Bernard, and K. Smith, “Efficacy of pre-hospital rapid sequence intubation in paediatric traumatic brain injury: a 9-year observational study,” Injury, vol. 49, no. 5, pp. 916–920, 2018. G. L. Foltin, P. Dayan, M. Tunik et al., “Priorities for pediatric prehospital research,” Pediatric Emergency Care, vol. 26, no. 10, pp. 773–777, 2010. A. Cooper, C. DiScala, G. Foltin, M. Tunik, D. Markenson, and C. Welborn, “Prehospital endotracheal intubation for severe head injury in children: a reappraisal,” Seminars in Pediatric Surgery, vol. 10, no. 1, pp. 3–6, 2001. P. Demaret, F. Lebrun, P. Devos et al., “Pediatric pre-hospital emergencies in Belgium: a 2-year national descriptive study,” European Journal of Pediatrics, vol. 175, no. 7, pp. 921–930, 2016. A. P. Hawkes, “A prospective multicenter evaluation of prehospital airway management performance in a large metropolitan region,” Prehospital Emergency Care, vol. 13, no. 3, pp. 304–310, 2009. W. C. Boswell, N. McElveen, M. Sharp, C. R. Boyd, and E. I. Frantz, “Analysis of prehospital pediatric and adult intubation,” Air Medical Journal, vol. 14, no. 3, pp. 125–128, 1995. S. Bankole, A. Asuncion, S. Ross et al., “First responder performance in pediatric trauma: a comparison with an adult cohort∗,” Pediatric Critical Care Medicine, vol. 12, no. 4, pp. e166–e170, 2011. J. Tweed, T. George, C. Greenwell, and L. Vinson, “Prehospital airway management examined at two pediatric emergency centers,” Prehospital and Disaster Medicine, vol. 33, no. 5, pp. 532–538, 2018 Denver Metro Airway Study Group, “A prospective multicenter evaluation of prehospital airway management performance in a large metropolitan region,” Prehospital Emergency Care, vol. 13, pp. 304–310, 2009. M. Hansen, W. Lambert, J.-M. Guise, C. R. Warden, N. C. Mann, and H. Wang, “Out-of-hospital pediatric airway management in the United States,” Resuscitation, vol. 90, pp. 104–110, 2015. A. G. Garza, D. A. Algren, M. C. Gratton, and O. J. Ma, “Populations at risk for intubation nonattempt andFailure in the prehospital setting,” Prehospital Emergency Care, vol. 9, no. 2, pp. 163–166, 2005. S. Bhananker, J. Harless, and R. Ramaiah, “Pediatric airway management,” International Journal of Critical Illness and Injury Science, vol. 4, no. 1, pp. 65–70, 2014. D. Rivera and E. Díaz, “Vía aérea pediátrica. ¿Tan difícil como dicen?” Rev Colomb Anestesiol, vol. 46, pp. 52–57, 2018. M. Tarpgaard, T. Hansen, and L. Rognås, “Anaesthetist-provided pre-hospital advanced airway management in children: a descriptive study,” Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine, vol. 23, p. 61, 2015. K. Ruetzler, P. Krafft, and M. Frass, “Airway management in intensive care medicine,” Benumof and Hagberg’s Airway Management, pp. 916–954, 2013. L. M. Phipps, N. J. Thomas, R. K. Gilmore et al., “Prospective assessment of guidelines for determining appropriate depth of endotracheal tube placement in children∗,” Pediatric Critical Care Medicine, vol. 6, no. 5, pp. 519–522, 2005. T. Simons, T. Söderlund, and L. Handolin, “Radiological evaluation of tube depth and complications of prehospital endotracheal intubation in pediatric trauma: a descriptive study,” European Journal of Trauma and Emergency Surgery, vol. 43, no. 6, pp. 797–804, 2017. M. L. Langhan, B. L. Emerson, S. Nett et al., “End-tidal carbon dioxide use for tracheal intubation,” Pediatric Critical Care Medicine, vol. 19, no. 2, pp. 98–105, 2018. B. K. Walsh, D. N. Crotwell, and R. D. Restrepo, “Capnography/capnometry during mechanical ventilation: 2011,” Respiratory Care, vol. 56, no. 4, pp. 503–509, 2011. S. Al-Shaqsi, “Models of international emergency medical service (EMS) Systems,” Oman Medical Journal, vol. 25, pp. 320–323, 2010. W. F. Dick, “Anglo-American vs. Franco-German emergency medical services system,” Prehospital and Disaster Medicine, vol. 18, no. 1, pp. 29–37, 2003. A. Schmidt, L. Ulrich, B. Seifert, R. Albrecht, D. Spahn, and P. Stein, “Ease and difficulty of pre-hospital airway management in 425 paediatric patients treated by a helicopter emergency medical service: a retrospective analysis,” Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine, vol. 24, no. 1, p. 22, 2016. J. N. Carlson, E. Gannon, N. C. Mann et al., “Pediatric out-of-hospital critical procedures in the United States∗,” Pediatric Critical Care Medicine, vol. 16, no. 8, pp. e260–e267, 2015. C. Eich, M. Roessler, M. Nemeth, S. G. Russo, J. F. Heuer, and A. Timmermann, “Characteristics and outcome of prehospital paediatric tracheal intubation attended by anaesthesia-trained emergency physicians,” Resuscitation, vol. 80, no. 12, pp. 1371–1377, 2009. T. H. Harrison, S. H. Thomas, and S. K. Wedel, “Success rates of pediatric intubation by a non-physician-staffed critical care transport service,” Pediatric Emergency Care, vol. 20, no. 2, pp. 101–107, 2004. G. M. Vilke, P. J. Steen, A. M. Smith, and T. C. Chan, “Out-of-hospital pediatric intubation by paramedics: the San Diego experience,” The Journal of Emergency Medicine, vol. 22, no. 1, pp. 71–74, 2002. R. F. Lavery, B. J. Tortella, and C. C. Griffin, “The prehospital treatment of pediatric trauma,” Pediatric Emergency Care, vol. 8, no. 1, pp. 9–12, 1992. J. E. Pointer, “Clinical characteristics of paramedics’ performance of pediatric endotracheal intubation,” The American Journal of Emergency Medicine, vol. 7, no. 4, pp. 364–366, 1989. P. Aijian, A. Tsai, R. Knopp, and G. W. Kallsen, “Endotracheal intubation of pediatric patients by paramedics,” Annals of Emergency Medicine, vol. 18, no. 5, pp. 489–494, 1989. |
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Higuita Gutiérrez, Luis FelipeRodríguez, Jhon JairoCarrillo Garcia, Edwar ArturoCastaño Betancur, EsneiderLuna Londoño, MauricioRestrepo Vargas, Sara20202020-11-25T17:49:42Z2020-11-25T17:49:42Z2020-05-0220902840https://doi.org/10.1155/2020/7012508https://hdl.handle.net/20.500.12494/28268Rodríguez, J. J., Higuita-Gutiérrez, L. F., Carrillo García, E. A., Castaño Betancur, E., Luna Londoño, M., & Restrepo Vargas, S. (2020). Meta-Analysis of Failure of Prehospital Endotracheal Intubation in Pediatric Patients. Emergency medicine international, 2020, 7012508. https://doi.org/10.1155/2020/7012508Prehospital care is essential for airway preservation in pediatric patients who require early endotracheal intubation to improve oxygenation and prevent aspiration. However, high frequencies of failure of endotracheal intubation have been reported for this age group. We aimed to analyze the frequency of failure of endotracheal intubation in pediatric patients within a prehospital context and compare it with adult patients. Thus, a systematic revision of literature with a meta-analysis was performed using a study search and selection strategy ensuring extensiveness, sensitivity, and reproducibility. Meta-analyses were performed for odds ratio, DerSimonian and Laird’s Q test was used to assess heterogeneity, and Egger and Begg’s test was used to assess publication bias. Overall, 17 papers and 8772 patients were included, and the main cause of prehospital care was assessed to be trauma. Failed endotracheal intubation frequency was 0.4%–52.6% in pediatric patients. The most frequent complication was with esophageal intubation. Forest plot suggests that risk of failure during intubation of pediatric patients is 3.54 fold higher than that observed for adults. It was concluded that airway management in pediatric patients within a prehospital context is a challenge for prehospital care providers because it entails clear physiological and anatomical differences and a low frequency of exposure to this kind of events as opposed to adults. These differences support a widely higher risk of failure of intubation, suggesting the necessity of consistently trained prehospital care providers to ensure proficiency in technique as well as availability of the required equipment.https://scienti.minciencias.gov.co/cvlac/visualizador/generarCurriculoCv.do?cod_rh=0001501791https://orcid.org/0000-0003-1361-3124https://scienti.minciencias.gov.co/gruplac/jsp/visualiza/visualizagr.jsp?nro=00000000011355luis.higuita@campusucc.edu.cojhonj.rodriguez@campusucc.edu.coedwar.carrillog@campusucc.edu.coesneider.castanob@campusucc.edu.comauricio.lunal@campusucc.edu.cosara.restrepova@campusucc.edu.co8Universidad Cooperativa de Colombia, Facultad de Ciencias de la Salud, Medicina, Medellín y EnvigadoHindawiMedicinaMedellínhttps://www.hindawi.com/journals/emi/2020/7012508/Emergency Medicine InternationalA. Thind, R. Hsia, J. Mabweijano, E. R. Hicks, A. Zakariah, and C. N. Mock, “Prehospital and emergency care,” in Essential Surgery: Disease Control Priorities, vol. 1, pp. 245–262, World Bank, Washington, DC, USA, 3rd edition, 2015.A. Mehmood, A. Rowther, O. Kobusingye, and A. Hyder, “Assessment of pre-hospital emergency medical services in low-income settings using a health systems approach,” International Journal of Emergency Medicine, vol. 11, pp. 53–63, 2018.J. L. Arnold, “International emergency medicine and the recent development of emergency medicine worldwide,” Annals of Emergency Medicine, vol. 33, no. 1, pp. 97–103, 1999.A. M. K. Harmsen, G. F. Giannakopoulos, P. R. Moerbeek, E. P. Jansma, H. J. Bonjer, and F. W. Bloemers, “The influence of prehospital time on trauma patients outcome: a systematic review,” Injury, vol. 46, no. 4, pp. 602–609, 2015.F. Jewkes, “Current topic: prehospital emergency care for children,” Archives of Disease in Childhood, vol. 84, no. 2, pp. 103–105, 2001.H. H. Kyu, C. E. Stein, C. Boschi Pinto et al., “Causes of death among children aged 5-14 years in the WHO European Region: a systematic analysis for the Global Burden of Disease Study 2016,” The Lancet Child & Adolescent Health, vol. 2, no. 5, pp. 321–337, 2018.R. J. Winchell and D. Hoyt, “Endotracheal intubation in the field improves survival in patients with severe head injury,” Archives of Surgery, vol. 132, no. 6, pp. 592–597, 1997.J. G. Hardman and J. S. Wills, “The development of hypoxaemia during apnoea in children: a computational modelling investigation,” British Journal of Anaesthesia, vol. 97, no. 4, pp. 564–570, 2006.P. E. Sirbaugh, P. E. Pepe, J. E. Shook et al., “A prospective, population-based study of the demographics, epidemiology, management, and outcome of out-of-hospital pediatric cardiopulmonary arrest,” Annals of Emergency Medicine, vol. 33, no. 2, pp. 174–184, 1999.T. B. Borja, M. E. Cruz, M. M. Medina, and G. E. Benitez, “Atención prehospitalaria del niño accidentado grave,” Journal of the Mexican Association of Critical Medicine and Intensive Therapy, vol. 16, pp. 185–200, 2002.P. F. Ehrlich, P. S. Seidman, O. Atallah, A. Haque, and J. Helmkamp, “Endotracheal intubations in rural pediatric trauma patients,” Journal of Pediatric Surgery, vol. 39, no. 9, pp. 1376–1380, 2004.P. C. Echeverry Marín and T. Engelhardt, “Algoritmo para el manejo de la vía aérea difícil en pediatría,” Revista Colombiana de Anestesiología, vol. 42, no. 4, pp. 325–334, 2014.N. Jagannathan, L. Sohn, and J. Fiadjoe, “Paediatric difficult airway management: what every anaesthetist should know!,” British Journal of Anaesthesia, vol. 117, pp. i3–i5, 2016.J. B. Orenstein, “Prehospital pediatric airway management,” Clinical Pediatric Emergency Medicine, vol. 7, no. 1, pp. 31–37, 2006.M. Hansen, G. Meckler, K. OʼBrien et al., “Pediatric airway management and prehospital patient safety,” Pediatric Emergency Care, vol. 32, no. 9, pp. 603–607, 2016.S. Heschl, B. Meadley, E. Andrew, W. Butt, S. Bernard, and K. Smith, “Efficacy of pre-hospital rapid sequence intubation in paediatric traumatic brain injury: a 9-year observational study,” Injury, vol. 49, no. 5, pp. 916–920, 2018.G. L. Foltin, P. Dayan, M. Tunik et al., “Priorities for pediatric prehospital research,” Pediatric Emergency Care, vol. 26, no. 10, pp. 773–777, 2010.A. Cooper, C. DiScala, G. Foltin, M. Tunik, D. Markenson, and C. Welborn, “Prehospital endotracheal intubation for severe head injury in children: a reappraisal,” Seminars in Pediatric Surgery, vol. 10, no. 1, pp. 3–6, 2001.P. Demaret, F. Lebrun, P. Devos et al., “Pediatric pre-hospital emergencies in Belgium: a 2-year national descriptive study,” European Journal of Pediatrics, vol. 175, no. 7, pp. 921–930, 2016.A. P. Hawkes, “A prospective multicenter evaluation of prehospital airway management performance in a large metropolitan region,” Prehospital Emergency Care, vol. 13, no. 3, pp. 304–310, 2009.W. C. Boswell, N. McElveen, M. Sharp, C. R. Boyd, and E. I. Frantz, “Analysis of prehospital pediatric and adult intubation,” Air Medical Journal, vol. 14, no. 3, pp. 125–128, 1995.S. Bankole, A. Asuncion, S. Ross et al., “First responder performance in pediatric trauma: a comparison with an adult cohort∗,” Pediatric Critical Care Medicine, vol. 12, no. 4, pp. e166–e170, 2011.J. Tweed, T. George, C. Greenwell, and L. Vinson, “Prehospital airway management examined at two pediatric emergency centers,” Prehospital and Disaster Medicine, vol. 33, no. 5, pp. 532–538, 2018Denver Metro Airway Study Group, “A prospective multicenter evaluation of prehospital airway management performance in a large metropolitan region,” Prehospital Emergency Care, vol. 13, pp. 304–310, 2009.M. Hansen, W. Lambert, J.-M. Guise, C. R. Warden, N. C. Mann, and H. Wang, “Out-of-hospital pediatric airway management in the United States,” Resuscitation, vol. 90, pp. 104–110, 2015.A. G. Garza, D. A. Algren, M. C. Gratton, and O. J. Ma, “Populations at risk for intubation nonattempt andFailure in the prehospital setting,” Prehospital Emergency Care, vol. 9, no. 2, pp. 163–166, 2005.S. Bhananker, J. Harless, and R. Ramaiah, “Pediatric airway management,” International Journal of Critical Illness and Injury Science, vol. 4, no. 1, pp. 65–70, 2014.D. Rivera and E. Díaz, “Vía aérea pediátrica. ¿Tan difícil como dicen?” Rev Colomb Anestesiol, vol. 46, pp. 52–57, 2018.M. Tarpgaard, T. Hansen, and L. Rognås, “Anaesthetist-provided pre-hospital advanced airway management in children: a descriptive study,” Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine, vol. 23, p. 61, 2015.K. Ruetzler, P. Krafft, and M. 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Kallsen, “Endotracheal intubation of pediatric patients by paramedics,” Annals of Emergency Medicine, vol. 18, no. 5, pp. 489–494, 1989.IntubationPediatricMeta-AnalysisIntubationPediatricMeta-AnalysisMeta-Analysis of failure of prehospital endotracheal intubation in pediatric patientsArtículohttp://purl.org/coar/resource_type/c_6501http://purl.org/coar/resource_type/c_2df8fbb1http://purl.org/coar/version/c_970fb48d4fbd8a85info:eu-repo/semantics/articleinfo:eu-repo/semantics/publishedVersionAtribucióninfo:eu-repo/semantics/openAccesshttp://purl.org/coar/access_right/c_abf2PublicationORIGINAL2020_Rodriguez_HiguitaGutiérrez_Metanalysis_ prehospital_ intubation.pdf2020_Rodriguez_HiguitaGutiérrez_Metanalysis_ prehospital_ intubation.pdfArtículoapplication/pdf1337080https://repository.ucc.edu.co/bitstreams/2b0d858f-fb05-4afd-b5d3-734f55662b00/downloadb1dd52cdd436f9d81cb50a0324efcd1fMD53LICENSElicense.txtlicense.txttext/plain; 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