September 26, 2019
Focus | Supraglottic Airway Devices in Pediatric Emergency Care Settings
Extraglottic devices or supraglottic airways (SGA) have been used in the United States since the early 1990s with the Laryngeal Mask Airway (LMA) being one of the first devices. SGAs were initially used in the anesthesiology setting but have rapidly expanded to the out-of-hospital setting over the last decade either as an initial airway or after a failed intubation attempt.

The use of SGAs in children managed by EMS is becoming more common. Reasons for this include:
  • increased availability of pediatric sized SGA device options
  • challenges and controversies regarding pediatric endotracheal intubation by US paramedics
  • rapid learning skill curve for successful placement of SGA devices with most providers able to successfully insert SGA in simulated difficult pediatric airway scenarios within 30 - 60 seconds.

Why is this important?

  • More children will be arriving to the ED with SGA devices in place in the future
  • Pediatric SGAs are rarely placed in the ED setting as an initial airway
  • ED physicians, nurses and respiratory therapists will need to be knowledgeable about the different types of SGAs and how to remove them or transition to intubation
  • Rapid removal of a functioning SGA device without a well-considered plan or knowledge of the device may lead to aspiration, hypoxemia, or loss of the airway.

What is happening in Florida?

  • In 2018 there were 358 intubations reported for ages 0-18 years; 249 to date for 2019
  • In 2018 there were 109 SGA’s reported for ages 0-18 years; 88 to date for 2019
  • The use of SGA’s in pediatric patients is showing an upward trend over the last 4 years
  • Peak ages for intubation/SGA are the <1 year and 15-18-year-old categories

*Data abstracted from EMSTARS, Florida’s prehospital EMS tracking and reporting system. As of December 2018, 199 of 280 (71%) licensed Florida EMS agencies were reporting to EMSTARS, accounting for 88% of all emergency calls.
 
Key Points:

  • EMS should always alert the ED that a SGA is in place during the dispatch report, including brand and size if possible and weight/color zone/age of the child
  • Size the extraglottic device based on ideal weight
  • Be sure to secure the SGA with some type of holding device or strap until ready for removal or exchange
  • The array of commercially available products is rapidly changing and EMS agencies have varying protocols regarding the use of SGAs.
  • Before stocking/purchasing a device, review manufactures sizing information and determine if pediatric sizes are available and other key characteristics
  • EMS agencies should communicate with their local EDs regarding their pediatric SGA policy and if they change brand or type of SGA device
Examples of Extraglottic Devices Used by EMS for SGA Management:*
Click here or on the image to view as a PDF with hyperlinks
*Based on current manufacturer information and literature, including Managing the Out-of-Hospital Extraglottic Airway Device

Florida PEDReady/EMSC and EMLRC do not recommend a particular device. Decisions are made at a local level. When reviewing resources, be mindful that older material will not contain accurate pediatric size availability information. 
Literature & Resources:
  • Managing the Out-of-Hospital Extraglottic Airway Device by D Braude, M Steuerwald, T Wray and R Galgon. (Must-read article! This is an excellent review of extraglottic devices with supplemental videos.)
  • Read on doi.org
  • Read on Annals of Emergency Medicine
  • View supplemental materials

 


Do you have a pediatric SGA protocol, experience or video to share? Email pedready@jax.ufl.edu
Upcoming Pediatric Emergency Events
NAEMT Emergency Pediatric Care Course
September 30 & October 3, 2019 | 8:30-4:30 pm | Jacksonville, FL
Hosted by: TraumaOne Flight Services

This 2-day (16-hour) Emergency Pediatric Care (EPC) course focuses on critical pediatric physiology, illnesses, injuries and interventions to help EMS practitioners provide the best treatment for sick and injured children. EPC is appropriate for EMTs, paramedics, emergency medical responders, nurses, nurse practitioners, physician assistants and physicians. Accredited by CAPCE; recognized by NREMT and Florida EMS for 16 CE hours.

Children's Disaster Services Workshop
October 11-12, 2019 | Tampa, FL
Hosted by: Child Life Disaster Relief

This is a specialized training for Certified Child Life Professionals only. Certified child life specialists are invited to register. Ten PDU’s are available.
2019 Bay Area Trauma Symposium (new!)
October 29-30, 2019 | St. Petersburg, FL
Hosted by: Bayfront Health St. Petersburg & Johns Hopkins All Children's Hospital

Experts in pediatric and adult trauma will discuss a range of current issues. Day 1 will cover pediatric trauma; day 2 will cover adult trauma. Registration fee is $25/day.

NAEMT Principles of Ethics & Personal Leadership Course
November 6-7, 2019 | 8:30-4:30 pm | St. Augustine, FL
Hosted by: TraumaOne Flight Services

This 2-day (16-hour) course provides EMS and Mobile Healthcare (MHC) practitioners with the skills to effectively interact with patients and their families, other medical personnel, co-workers, supervisors and community residents. This course is appropriate for EMTs, paramedics, other MHC practitioners and emergency responders. Upon successful completion, students receive a certificate, wallet card
(good for 4 years) and 16 hours of CAPCE credit.

Pediatric Care After Resuscitation (PCAR) Course
Dec 2-3, 2019 | Jacksonville, FL

The mission of TCAR (Trauma Care After Resuscitation) Education Programs is to expand the knowledge base and clinical reasoning skills of nurses who work with injured patients anywhere along the trauma continuum of care, particularly in the post-resuscitation phase. 
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The Florida PEDReady Program
pedready@jax.ufl.edu | 904-244-8617