Project Details
Description
PROJECT SUMMARY
We aim to answer the signature question of paramedic care; “What is the best way to manage the
prehospital airway in critically ill children?” Cardiac arrest, respiratory failure, and major trauma are
devastating critical conditions in children. Resuscitation from critical illness requires skillful airway
management to optimize delivery of oxygen to the lungs, preventing irreparable damage to the brain and
heart. As the first to provide critical care, prehospital paramedics often perform life-saving airway management
on critically ill children. The most common prehospital airway management techniques (bag-valve-mask
ventilation (BVM), endotracheal intubation (ETI), and supraglottic airway insertion (SGA) have important trade-
offs between risks and benefits; the best approach is unknown.
We propose the novel Pediatric Prehospital Airway Resuscitation Trial (Pedi-PART) to determine
the best strategies for prehospital airway management in critically ill children. Pedi-PART will
immediately influence paramedic practices and have a lasting impact upon the health of children
internationally. We will determine the relative effectiveness of three airway strategies ([BVM-only], [BVM+ETI],
[BVM+SGA]), accounting for variations across disease (cardiac arrest, trauma, respiratory failure) and age
categories, and we will apply adaptive techniques to minimize the required number of patients. Our aims are:
AIM I: Prepare the Pediatric Emergency Care Applied Research Network (PECARN) to execute the
innovative Pedi-PART trial. PECARN is the nation’s premier pediatric emergencies research network. We
have assembled an alliance of over 60 EMS agencies from 10 communities associated with PECARN and their
ongoing Pediatric Dose Optimization for Seizures in EMS trial (PediDOSE - U01-NS114042).
AIM II: Compare the effectiveness of prehospital BVM, SGA, and ETI airway management strategies
upon pediatric cardiac arrest, major trauma, and respiratory failure outcomes. We will execute the trial in
two sequential stages. Stage I: Determine if [BVM-only] or [BVM followed by SGA] results in better ICU-free
survival in critically ill children with cardiac arrest, major trauma, or respiratory failure. Stage II: Determine if
[winner of Stage I] or [BVM followed by ETI] results in better ICU-free survival.
AIM III: Compare the safety of prehospital BVM, SGA, and ETI airway management strategies in
pediatric cardiac arrest, major trauma, and respiratory failure. In Stage I, we will determine if [BVM+SGA]
results in fewer prehospital and hospital adverse events compared with [BVM-only] in critically ill children with
cardiac arrest, major trauma, or respiratory failure. In Stage II, we will determine if the winner of Stage I results
in fewer adverse events compared with [BVM+ETI].
Status | Active |
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Effective start/end date | 09/1/23 → 07/31/24 |
Funding
- National Heart, Lung, and Blood Institute: $1,902,731.00
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