Improving the Safety and Efficacy of Out-of-Hospital Pediatric Airway Management

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Project Summary: I propose a 4-year mentored research training program to become a leader in the field of pediatric emergency care research. I am residency-trained in Emergency Medicine and fellowship-trained in Pediatric Emergency Medicine and am currently Assistant Professor of Emergency Medicine at Oregon Health & Science University. My research focuses on improving safety in the out-of-hospital care of pediatric patients. This proposal focuses specifically on improving the safety of pediatric airway management during out-of-hospital emergencies and studying the efficacy of supraglottic airway devices. My career development plan will provide me advanced skills in decision science, qualitative research, biostatistics, exception from informed consent, and clinical trial design that are critical to advance this field and my career. The training will come through formal coursework, mentored research, experiential learning, focused reading programs, and scientific meetings. The overall objective of this proposal is to test whether supraglottic airway devices are superior to endotracheal intubation and bag-valve-mask ventilation for out-of-hospital pediatric airway management. Endotracheal intubation, a complex and invasive procedure, is the single most common out-of- hospital advanced airway technique and the gold standard in the hospital. However, up to 50% of out-of- hospital pediatric endotracheal intubations are complicated by endotracheal tube misplacement and/or dislodgement, hypoxia, hypercapnia, or damage to airway structures. Bag-valve-mask ventilation is less invasive but challenging in the out-of-hospital environment given the need to provide care in a moving vehicle. There is critical need for a new approach that reduces complications and is effective in oxygenation and ventilation. The central hypothesis of this proposal is to understand whether supraglottic airway devices, commonly used in children in the operating room, are more effective than endotracheal intubation and bag-valve-mask ventilation for out-of-hospital emergency airway management. To test this hypothesis we will 1) examine the efficacy of supraglottic airway devices being used by paramedics in simulation lab and operating room environments; 2) conduct a qualitative study to understand the decision making process used in out-of-hospital pediatric airway management and identify potential barriers to implementation of supraglottic airway devices; and 3) conduct a prospective observational study to determine how the airway management strategy affects CPR quality and medication administration in pediatric out-of- hospital cardiac arrest. This research will help improve out-of-hospital pediatric airway management by helping understand how individual device characteristics, provider factors, and clinical context affect the efficacy and safety of airway management techniques.