Adverse events in pediatric orotracheal intubation in the pediatric emergency department: systematic review and meta-analysis.

Objective: This study aims to systematically review all adverse events (AEs) associated with orotracheal intubation in pediatric patients, with the ultimate goal of aiding healthcare center administration in establishing evidence-based guidelines and devising preventive strategies to mitigate AEs in pediatric intubation procedures.

Methods: Systematic automated searches across pivotal databases were conducted up to 2023. The screening process was facilitated by EndNote X9 following the importation of citations. Data extraction was guided by predefined eligibility criteria after the elimination of duplicates and ineligible publications. The National Institutes of Health (NIH) quality evaluation instrument was employed to assess biases.

Results: A total of twenty-four studies spanning from 2002 to 2023, encompassing 7135 patients were included in the analysis. Among the identified adverse events, moderate desaturation(≤90%) emerged as the most prevalent, affecting 508/2398 (23.9%, 95% CI: 17.6% to 30.3%) of cases across 13 studies. Mainstem intubation was observed in 342 out of 4,481 cases (9.1%, 95% CI: 6.3% to 11.9%) and in 173 out of 3903 cases (3.9%, 95% CI: 2.5% to 5.3%), making these significant AEs. Cardiac complications, including arrhythmias 55/3858 (1.2%, 95% CI: 0.6% to 1.8%), hypotension 121/4536 (2.6%, 95% CI: 1.5% to 3.7%), and cardiac arrest 105/4836 (1.4%, 95% CI: 0.7% to 2.2%), were observed in 10, 11, and 11 trials, respectively. Severe complications, with an incidence rate of 274/3298 (8.8%, 95% CI: 4.2% to 13.3%), were reported in five studies.

Conclusion: This comprehensive investigation and subsequent meta-analysis of adverse events associated with pediatric intubation provide valuable insights that can inform the development of enhanced safety protocols and evidence-based guidelines for pediatric emergency care.

Impact: High Success Rate with Complications: An 84.7% intubation success rate is reported, with a 30.1% complication rate, including desaturation, mainstem and esophageal intubation, and cardiac issues. Need for Enhanced Safety Measures: Findings stress the importance of better training and standardized protocols to reduce complications in pediatric emergency intubation. Focus on Adverse Events: This study uniquely highlights adverse events, offering crucial data for developing guidelines to improve safety in pediatric intubation.