TOP 36 - PREVENT-ED: PediatRic Emergency VENtilation Trial in the Emergency Department

Publication Number: 4738.TOP 36

Megan Danzo, Washington University in St. Louis School of Medicine, Saint Louis, MO, United States; Lindsay Clukies, WashU, Saint Louis, MO, MO, United States; Fahd A. Ahmad, Washington University in St. Louis, St. Louis, MO, United States; Jinli Wang, Washington University in St. Louis School of Medicine, chesterfield, MO, United States; Kavya A. John, Washington University School of Medicine, St. Louis, MO, United States; Jeffrey Siegler, Washington University in St. Louis School of Medicine, Saint Louis, MO, United States; Lisa M. Cracchiolo, St. Louis Children's Hospital, St. Louis, MO, United States; Joseph Finney, Washington University in St. Louis School of Medicine, Saint Louis, MO, United States

Background: Manual ventilation is a critical, life-saving intervention commonly performed in the pediatric emergency department (ED). However, when performed incorrectly, it can be harmful to patients. Delivering too much or too little volume, or ventilating too rapidly or slowly, has been associated with increased mortality in animal models and adults. Although, the American Heart Association (AHA) provides guidelines for appropriate pediatric ventilation, simulation and in-hospital observational studies have shown that incorrect ventilation remains common and fails to improve with education alone. Despite its frequency and importance in pediatric resuscitation, manual ventilation performance of pediatric patients in the ED has not been previously evaluated.

Objective: The primary objective of this study was to evaluate the performance of manual ventilation in the pediatric ED using a ventilation recording device. Secondary objectives were to analyze the indication for manual ventilation, evaluate changes in blood gas values based on ventilation performance, and describe patient outcomes for those requiring manual ventilation in the ED.

Design/Methods: We conducted a prospective observational study of patients aged 1 to 18 years old requiring manual ventilation in a tertiary care pediatric ED, which serves as a regional level 1 trauma center and treats over fifty thousand patients annually. The study was approved by the IRB. A ventilation recording device was inserted between the bag-valve and mask or advanced airway device. The device silently measured tidal volume, respiratory rate, and air leak while the provider performed manual ventilation as they normally would. The patients were ventilated by respiratory therapists; pediatric and emergency medicine residents; or pediatric emergency medicine fellows and attending physicians. We collected data for the first two minutes of manual ventilation. We compared observed ventilation data to AHA guideline recommendations for ventilation. Additional data collected included patient demographics, reason for ED visit, indication for manual ventilation, medical history and blood gas results. Data analysis is anticipated to be completed by the end of the calendar year. For the analysis, we will report the descriptive statistics including range, mean with standard deviation or median with interquartile range for the measurements of interest, including tidal volume, rates delivered to patients and the percent of time that these numbers were within the recommended range.

Figure 1: ventilation recording device
Figure 1 PAS.pdfFigure 1: The ventilation recording device inserted between the mask and the bag