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Peer-reviewedCC BY-NC-ND 4.0Pediatric Emergency Care

Early Successful Prehospital Advanced Airway Management and Outcomes in Pediatric Out-of-Hospital Cardiac Arrests

  • Shunsuke Amagasa1
  • Sho Komukai2
  • Masahiro Kashiura3
  • Hideto Yasuda3
  • Yuki Kishihara3
  • Satoko Uematsu1
  • Sriram Ramgopal4
  • Robert A. Berg5
  • Masashi Okubo6
6 affiliations
  1. 1Department of Emergency and Transport Medicine, National Center for Child Health and Development, Setagaya-ku, Tokyo, Japan
  2. 2Department of Health Data Sciences, Tokyo Medical University, Shinjuku-ku, Tokyo, Japan
  3. 3Department of Emergency and Critical Care Medicine, Saitama Medical Center, Jichi Medical University, Omiya-ku, Saitama City, Saitama, Japan
  4. 4Department of Pediatrics, Division of Pediatric Emergency Medicine, Ann and Robert H. Lurie Children’s Hospital of Chicago, Chicago, IL
  5. 5Department of Anesthesiology and Critical Care Medicine, Children’s Hospital of Philadelphia, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA
  6. 6Department of Emergency Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA
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Abstract

Objectives:: While advanced airway management (AAM) is commonly performed for children with out-of-hospital cardiac arrest (OHCA), the benefit and optimal timing of AAM remains unclear. To determine whether earlier prehospital AAM is associated with patient outcomes compared with later or no AAM in children with OHCA.

Methods:: Retrospective cohort study of pediatric patients (aged <18 years) with nontraumatic OHCA treated by emergency medical services (EMS), using the Resuscitation Outcomes Consortium Epidemiologic Registry–Cardiac Arrest at 10 sites in the United States and Canada from April 2011 to June 2015. The exposures are early prehospital AAM (defined as successful AAM within 10 minutes of EMS arrival) and any successful prehospital AAM (endotracheal intubation or supraglottic airway placement). The primary outcome was survival to hospital discharge. Children who received successful prehospital AAM at each minute after EMS arrival were matched, using time-dependent propensity scores, to children at risk of AAM in the same minute.

Results:: Among 954 eligible pediatric patients (median [IQR] age, 1 [0 to 11] years), 521 (54.6%) received prehospital AAM, and 433 (45.4%) did not. Overall, 91 (9.5%) survived to discharge. In the propensity score-matched cohort (922 matched cases), successful AAM ≤10 minutes was associated with higher likelihood of survival to hospital discharge (risk ratio [RR], 1.93; 95% CI, 1.01-3.70) compared with children at risk of receiving AAM. In contrast, when successful prehospital AAM was considered regardless of timing, any successful AAM was not associated with survival (RR, 1.35; 95% CI, 0.75-2.43).

Conclusions:: In this North American cohort of pediatric OHCA, earlier AAM (successful AAM within 10 minutes) was associated with survival to hospital discharge. However, successful prehospital AAM at any time was not associated with survival to hospital discharge. These findings suggest that performing AAM earlier in the resuscitation may have a potential benefit for children with OHCA.

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Cite

BibTeXRIS
BibTeX
@article{amagasa2026early,
  title = {{Early Successful Prehospital Advanced Airway Management and Outcomes in Pediatric Out-of-Hospital Cardiac Arrests}},
  author = {Shunsuke Amagasa and Sho Komukai and Masahiro Kashiura and Hideto Yasuda and Yuki Kishihara and Satoko Uematsu and Sriram Ramgopal and Robert A. Berg and Masashi Okubo},
  journal = {Pediatric Emergency Care},
  year = {2026},
  month = jul,
  doi = {10.1097/pec.0000000000003657},
  url = {https://doi.org/10.1097/pec.0000000000003657},
  note = {CC BY-NC-ND 4.0},
}
RIS
TY  - JOUR
TI  - Early Successful Prehospital Advanced Airway Management and Outcomes in Pediatric Out-of-Hospital Cardiac Arrests
AU  - Shunsuke Amagasa
AU  - Sho Komukai
AU  - Masahiro Kashiura
AU  - Hideto Yasuda
AU  - Yuki Kishihara
AU  - Satoko Uematsu
AU  - Sriram Ramgopal
AU  - Robert A. Berg
AU  - Masashi Okubo
PY  - 2026
DA  - 2026/07/27
JO  - Pediatric Emergency Care
DO  - 10.1097/pec.0000000000003657
UR  - https://doi.org/10.1097/pec.0000000000003657
AB  - Objectives:: While advanced airway management (AAM) is commonly performed for children with out-of-hospital cardiac arrest (OHCA), the benefit and optimal timing of AAM remains unclear. To determine whether earlier prehospital AAM is associated with patient outcomes compared with later or no AAM in children with OHCA.  Methods:: Retrospective cohort study of pediatric patients (aged <18 years) with nontraumatic OHCA treated by emergency medical services (EMS), using the Resuscitation Outcomes Consortium Epidemiologic Registry–Cardiac Arrest at 10 sites in the United States and Canada from April 2011 to June 2015. The exposures are early prehospital AAM (defined as successful AAM within 10 minutes of EMS arrival) and any successful prehospital AAM (endotracheal intubation or supraglottic airway placement). The primary outcome was survival to hospital discharge. Children who received successful prehospital AAM at each minute after EMS arrival were matched, using time-dependent propensity scores, to children at risk of AAM in the same minute.  Results:: Among 954 eligible pediatric patients (median [IQR] age, 1 [0 to 11] years), 521 (54.6%) received prehospital AAM, and 433 (45.4%) did not. Overall, 91 (9.5%) survived to discharge. In the propensity score-matched cohort (922 matched cases), successful AAM ≤10 minutes was associated with higher likelihood of survival to hospital discharge (risk ratio [RR], 1.93; 95% CI, 1.01-3.70) compared with children at risk of receiving AAM. In contrast, when successful prehospital AAM was considered regardless of timing, any successful AAM was not associated with survival (RR, 1.35; 95% CI, 0.75-2.43).  Conclusions:: In this North American cohort of pediatric OHCA, earlier AAM (successful AAM within 10 minutes) was associated with survival to hospital discharge. However, successful prehospital AAM at any time was not associated with survival to hospital discharge. These findings suggest that performing AAM earlier in the resuscitation may have a potential benefit for children with OHCA.
SN  - 0749-5161
SN  - 1535-1815
ER  -