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March 22, 2026Air Medical Journal1 citationsOpen Access

Evaluation of Prehospital Endotracheal Intubation in Pediatric Patients in a German Helicopter Emergency Medical Service: An Analysis of 920 Cases

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MRMelanie RudolphFRFlorian ReifferscheidLKLeopold Kies

Key Points

  • The aim is to evaluate the effectiveness of prehospital endotracheal intubation in pediatric patients within a helicopter emergency medical service.
  • Retrospective analysis of 920 pediatric intubation cases from 2012 to 2021.
  • Assessment of glottis visualization and first-pass intubation success rates.
  • Comparison of outcomes with and without the use of muscle relaxants.
  • Evaluation of airway management tools usage rates during intubation.
  • Intubation events occurred in 0.2% of all missions.
  • Good glottis visualization achieved in 96.3% of cases.
  • First-pass success rate was 86.6%, improving to 90.1% with muscle relaxants.
  • Tube malplacement occurred in 8.4% of cases when assuming pre-managed airways.

Abstract

A C T Management of the pediatric airway is a challenging procedure in prehospital emergency medicine.This retrospective study evaluates prehospital airway management in 920 pediatric patients in a German helicopter emergency medical service (HEMS) system from 2012 to 2021.Prehospital pediatric intubation was a rare event (0.2% of all missions).Good visualization of the glottis (Cormack-Lehane I or II) was possible in 96.3% of the intubations.The first-pass intubation success was 86.6%; all children could finally be intubated successfully.The use of muscle relaxants significantly improved first-pass success in prehospital emergency anesthesia (90.1% vs. 83.1%;P = .002).We recognized a low rate of the use of aids such as stylet, bougie, or video laryngoscopy.The use of video laryngoscopy increased over the years, but did not translate into a higher first-attempt success rate.When taking over children with an already managed airway, HEMS teams found tube malplacement in 8.4% of the cases in primary missions.In the analyzed data, pediatric airway management was on a comparable level with adult airway management.Nevertheless, room for improvement and a need for further studies were identified.

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Cite This Study

Rudolph et al. (2026) studied this question.

synapsesocial.com/papers/69bf86ecf665edcd009e90b0https://doi.org/10.1016/j.amj.2026.02.010
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