Checklist, Video Laryngoscope and Experience Improve the Success of Rapid Sequence Intubation in Children

Published July 2015
BJM Quality & Safety Online First

The challenge of performing rapid sequence intubation in a pediatric emergency department is complicated by its relative rare use and a resulting lack of experience with the procedure by the care providers who must perform it.

However, a multi-year research effort led by the Division of Emergency Medicine demonstrates success at improving outcomes, according to a study published in July 2015 in BJM Quality & Safety Online First.

The project began with videotape analysis of intubations from 2009-2010. The team identified key factors associated with performance gaps, including oxyhemoglobin desaturation in 33 percent of cases and frequent prolonged laryngoscopy attempts.

In 2012, an improvement initiative developed interventions to enhance safety and reliability. They included providing attending staff with a detailed checklist of specific intubation steps, use of a video laryngoscope, and restricting the procedure to more experienced providers.

Attending physicians Benjamin Kerrey, MD, and Srikant Iyer, MD, MPH, led an analysis of the changes, based on 75 videotaped intubations in 2015-2016. The team reports the near elimination of esophageal intubations and a reduction in children experiencing oxygen desaturation from 33 percent to 16 percent.

Now Kerrey is working with other institutions interested in adopting the Cincinnati-developed program.

“In a four-year period, we went from knowledge discovery through improvement and now into sustainability,” Kerrey says. “With safety as our focus, we reduced the rate of desaturation and got better at the procedure.”