LAUSR

Emergency intubation is a high-risk, low-frequency procedure for pediatric patients. Providers must perform emergency intubation for children competently and safely, yet exposure is rare for individual providers. The infrequency of exposure creates substantial challenges for trainees and established providers, limiting opportunities to achieve and maintain competency, to develop a confident and comprehensive approach, and, for patients, to minimize the risk of adverse events. Efficient placement of an endotracheal tube during the initial laryngoscopy attempt is a standard measure of procedural success. Compared with adults, for whom published rates of first-attempt success range from 75% to 83%, emergency intubation for children is generally less successful, with rates ranging from 33% to 83% in the emergency department and ICU and from 66% to 79% in the out-of-hospital setting. Adverse events are also more common in children, with oxyhemoglobin desaturation reported in 33% to 47% compared with 0.5% to 26% of adults. With efficient and safe intubation elusive for pediatric patients in a low-exposure environment, how do individuals performing this procedure respond?