1/2 – Pediatric Prehospital Airway Resuscitation Trial

项目摘要 我们的目标是回答护理人员护理的标志性问题;“什么是管理 危重患儿的院前气道？”心脏骤停呼吸衰竭和严重创伤 严重的儿童疾病。危重病复苏需要熟练的气道 管理，以优化氧气输送到肺部，防止对大脑造成不可挽回的损害， 心作为第一个提供重症监护的人，院前护理人员经常进行挽救生命的气道管理 重症儿童的治疗最常见的院前气道管理技术（袋-阀-面罩 通气（BVM）、气管插管（ETI）和声门上气道插入（SGA）具有重要的交易- 风险和收益之间的权衡;最好的方法是未知的。 我们提出了新的儿科院前气道复苏试验（Pedi-PART），以确定 危重患儿院前气道管理的最佳策略。Pedi-PART将 立即影响护理人员的做法，并对儿童的健康产生持久影响 化国际大我们将确定三种气道策略（[仅BVM]，[BVM+ETI]， [BVM+SGA]），说明了疾病（心脏骤停、创伤、呼吸衰竭）和年龄之间的差异 类别，我们将应用自适应技术，以尽量减少所需的病人人数。我们的目标是： 目的一：准备儿科急救应用研究网络（PECARN）， 创新的Pedi-PART试验。PECARN是美国首屈一指的儿科急诊研究网络。我们 已经组建了一个由来自10个社区的60多个EMS机构组成的联盟， 正在进行的EMS试验中癫痫发作的儿科剂量优化（PediDOSE -U 01-NS 114042）。 目的II：比较院前BVM、SGA和ETI气道管理策略的有效性 在小儿心脏骤停、严重创伤和呼吸衰竭的结果。我们将在2015年 两个连续的阶段。第I阶段：确定[仅BVM]或[BVM后SGA]是否可获得更好的无ICU效果 心脏骤停、严重创伤或呼吸衰竭的危重患儿的存活率。第二阶段：确定是否 [I期赢家]或[BVM后进行ETI]的无ICU生存率更高。 目的III：比较院前BVM、SGA和ETI气道管理策略的安全性， 小儿心脏骤停，严重外伤，呼吸衰竭在第一阶段，我们将确定[BVM+SGA] 与[仅使用BVM]相比， 心脏骤停严重创伤或呼吸衰竭在第二阶段，我们将决定第一阶段的赢家是否能够 与[BVM+ETI]相比，不良事件较少。

PROJECT SUMMARY We aim to answer the signature question of paramedic care; “What is the best way to manage the prehospital airway in critically ill children?” Cardiac arrest, respiratory failure, and major trauma are devastating critical conditions in children. Resuscitation from critical illness requires skillful airway management to optimize delivery of oxygen to the lungs, preventing irreparable damage to the brain and heart. As the first to provide critical care, prehospital paramedics often perform life-saving airway management on critically ill children. The most common prehospital airway management techniques (bag-valve-mask ventilation (BVM), endotracheal intubation (ETI), and supraglottic airway insertion (SGA) have important trade- offs between risks and benefits; the best approach is unknown. We propose the novel Pediatric Prehospital Airway Resuscitation Trial (Pedi-PART) to determine the best strategies for prehospital airway management in critically ill children. Pedi-PART will immediately influence paramedic practices and have a lasting impact upon the health of children internationally. We will determine the relative effectiveness of three airway strategies ([BVM-only], [BVM+ETI], [BVM+SGA]), accounting for variations across disease (cardiac arrest, trauma, respiratory failure) and age categories, and we will apply adaptive techniques to minimize the required number of patients. Our aims are: AIM I: Prepare the Pediatric Emergency Care Applied Research Network (PECARN) to execute the innovative Pedi-PART trial. PECARN is the nation’s premier pediatric emergencies research network. We have assembled an alliance of over 60 EMS agencies from 10 communities associated with PECARN and their ongoing Pediatric Dose Optimization for Seizures in EMS trial (PediDOSE - U01-NS114042). AIM II: Compare the effectiveness of prehospital BVM, SGA, and ETI airway management strategies upon pediatric cardiac arrest, major trauma, and respiratory failure outcomes. We will execute the trial in two sequential stages. Stage I: Determine if [BVM-only] or [BVM followed by SGA] results in better ICU-free survival in critically ill children with cardiac arrest, major trauma, or respiratory failure. Stage II: Determine if [winner of Stage I] or [BVM followed by ETI] results in better ICU-free survival. AIM III: Compare the safety of prehospital BVM, SGA, and ETI airway management strategies in pediatric cardiac arrest, major trauma, and respiratory failure. In Stage I, we will determine if [BVM+SGA] results in fewer prehospital and hospital adverse events compared with [BVM-only] in critically ill children with cardiac arrest, major trauma, or respiratory failure. In Stage II, we will determine if the winner of Stage I results in fewer adverse events compared with [BVM+ETI].