Operations and outcomes of a Hospital-wide Emergency Airway Response Team (HEART) in a quaternary academic children's hospital

Shakthi Jayanthy Venkatachalam; Annery Garcia-Marcinkiewicz; Rita Giordano; Joanne Stow; Janet Lioy; Luv Javia; Khoon-Yen Tay; Amy Romer; Leane Soorikian; Natalie Napolitano; John McCloskey; Vinay Nadkarni; John Fiadjoe; Akira Nishisaki

doi:10.1111/pan.14249

Operations and outcomes of a Hospital-wide Emergency Airway Response Team (HEART) in a quaternary academic children's hospital

Paediatr Anaesth. 2021 Oct;31(10):1105-1112. doi: 10.1111/pan.14249. Epub 2021 Jul 24.

Authors

Affiliations

¹ Center for Simulation, Advanced Education and Innovation, The Children's Hospital of Philadelphia, Philadelphia, PA, USA.
² Department of Anesthesiology and Critical Care, The Children's Hospital of Philadelphia, Philadelphia, PA, USA.
³ Department of Respiratory Care, The Children's Hospital of Philadelphia, Philadelphia, PA, USA.
⁴ Department of Otorhinolaryngology, The Children's Hospital of Philadelphia, Philadelphia, PA, USA.
⁵ Department of Neonatology, The Children's Hospital of Philadelphia, Philadelphia, PA, USA.
⁶ Department of Emergency Medicine, The Children's Hospital of Philadelphia, Philadelphia, PA, USA.
⁷ Department of Pediatric Anesthesia and Critical Care, Johns Hopkins Hospital, Baltimore, MD, USA.
⁸ Department of Anesthesia, Critical Care and Pain Medicine, Boston Children's Hospital, Boston, MA, USA.

PMID: 34176182
DOI: 10.1111/pan.14249

Abstract

Background: To improve pediatric airway management outside of the operating room, a Hospital-wide Emergency Airway Response Team (HEART) program composed of anesthesiology, otorhinolaryngology, and respiratory therapy clinicians was developed.

Aims: To report processes and outcomes of HEART activations in a quaternary academic children's hospital.

Methods: A retrospective observational cohort study between January 2017 and December 2019. Local airway emergency database was reviewed for HEART activations. Additional safety data was obtained from patients' electronic health records.

Primary outcome: Adverse airway outcomes, either adverse tracheal intubation-associated events or oxygen desaturation (SpO₂ <80%). We compared airway management by primary teams before HEART arrival and by HEART after arrival.

Results: Of 96 HEART activations, 36 were from neonatal intensive care unit, 35 from pediatric and cardiac intensive care units, 14 from emergency department, and 11 from inpatient wards. 56 (62%) children had airway anomalies and 41/96 (43%) were invasively ventilated. Median HEART arrival time was 5 min (interquartile range, 3-5). 56/96 (58%) required insertion of an advanced airway (supra/extra-glottic airway, endotracheal tube, tracheostomy tube). HEART succeeded in establishing a definitive airway in 53/56 (94%). Adverse airway outcomes were more common before (56/96, 58%) versus after HEART arrival (28/96, 29%; absolute risk difference 29%; 95% confidence interval 16, 41%; p < .001). Oxygen desaturation occurred more frequently before (46/96, 48%) versus after HEART arrival (24/96, 25%; absolute risk difference 23%; 95% confidence interval 11, 35%; p = .02). Cardiac arrests were more common before (9/96, 9%) versus after HEART arrival (3/96, 3%). Multiple (≥3) intubation attempts were more frequent before (14/42, 33%) versus after HEART arrival (9/46, 20%; absolute risk difference -14%; 95% confidence interval -32, 5%; p = .15).

Conclusions: A multidisciplinary emergency airway response team plays an important role in pediatric airway management outside of the operating room. Adverse airway outcomes were more frequent before compared to after HEART arrival.

Keywords: patient care team; pediatric airway management; retrospective cohort study.

Publication types

Observational Study

MeSH terms

Airway Management*
Child
Emergency Service, Hospital*
Hospitals, Pediatric
Humans
Infant, Newborn
Intensive Care Units, Neonatal
Intubation, Intratracheal
Retrospective Studies