229 - Association of full premedication with tracheal intubation success and tracheal intubation associated events in the neonatal intensive care unit.

Poster Board #: 229
Publication #: 2911-HP-QA.229

Background: Neonatal tracheal intubation (TI) is an important technical skill, however even highly experienced providers have average first attempt success rates (Haubner et al. 2013). Premedication has been studied as a means to improve outcomes of neonatal intubation (Ozawa et al 2019). The AAP supports the use of analgesics for non-emergent intubation (Kumar et al. 2010), and research by Foglia et al. (2019) found decreased tracheal intubation associated events (TIAEs) with use of paralytic medicine. It is not known whether there is a greater association with full vs. partial premedication on TI success rates and TIAEs.


Objective: Evaluate the association of full compared with partial premedication with Tracheal Intubation Associated Events (TIAEs) and first attempt success in the NICU.


Design/Methods: A retrospective cohort study in a single Level IV academic NICU participating in the prospective database the National Emergency Airway Registry for Neonates (NEAR4NEOS) from Dec 2018-Mar 2020 compared TI with full premedication (vagolytic, opiate analgesic, and paralytic agent) and TI without full premedication. Primary outcomes were associations between full premedication and number of TI attempts, first attempt success, and TIAEs.


Results: Data were collected on 111 TI encounters in 65 infants with a median of 29 weeks gestation and birth weight of 1100g. The use of full premedication increased from 0% in 2019 to 54% in 2020. Overall, full premedication was used in 32% (n=36) of total TI encounters, and resulted in fewer TI attempts (p=0.01), higher first attempt success (p=0.04), and fewer TIAEs (p<0.01). There was a trend toward less change in heart rate (mean of 33 bpm vs. 50 bpm from baseline) during intubation with full premedication (p=0.07), and fewer instances of severe bradycardia (HR <60 bpm) (p=0.02).

Conclusion(s): Compared to intubations without full premedication, use of full premedication resulted in fewer intubation attempts, higher first attempt success, and fewer adverse events. These findings will inform ongoing quality improvement initiatives to further increase utilization of full premedication.








Combined adverse events per intubation encounter

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Authors/Institutions: Sara Neches, University of Washington, Seattle, Washington, United States; Brianna K. Brei, University of Nebraska Medical Center, Omaha, Nebraska, United States; Megan M. Gray, University of Washington, Seattle, Washington, United States; Taylor L. Sawyer, University of Washington, Seattle, Washington, United States; Kirtikumar Upadhyay, University of Washington, Seattle, Washington, United States; Rachel A. Umoren, University of Washington, Seattle, Washington, United States; Akira Nishisaki, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, United States