The Utility of Atropine in Pediatric RSI - A Change in the Standard of Care
This study is a retrospective chart review of patients that were intubated in the ED at Children's Medical Center between January 1, 1995 to January 1, 2008. We will retrieve a database from our information services at Children Medical Center Dallas. We will extract the data using ICD-9 codes and the Division of Pediatric Emergency Medicine Code Review Database for Quality Improvement. This database will contain all pediatrics patients who were intubated using RSI from January 1, 1995 to January 1, 2008. From this database, we will access the electronic records of the qualifying subjects. We estimate that data will be collected on 500 subjects.
Patients who have been intubated using RSI will be reviewed in detail. The data collected will include: age, weight, past medical history, reason for intubation, ED diagnosis, and events surrounding the pre-intubation, intubation, and post-intubation phases. Data collected from the pre-intubation phase include: vital signs, medications, and dosages. Data collected from the intubation phase include: vital signs, intubation attempts, airway anatomy, and amount of secretions. Data collected from the post-intubation phase include: length of ICU stay and number of days on the ventilator. Data will also be collected on the complications as well as the interventions during intubation. The primary outcome for this study is bradycardia. The AHA defines bradycardia based on age as seen in the chart included in the protocol. We will be using the same criteria for bradycardia in our study.
A descriptive analysis of patient demographic, characteristics, medication dosing, and prevalence of adverse events will be performed using proportions, frequency distribution, means, and confidence intervals. Significance testing of the proportion of adverse events between patients who do and do not receive atropine will be tested by the use of chi-square exact tests, odds ratios, and confidence intervals. Similar sub-group analyses will be performed for demographic and other co-morbid conditions. The subgroups will be based on age (i.e. less than one year of age, 1 to 5 years of age, 5 to 10 years of age, and greater than ten years of age).
1. Patients 0-21 years of age
2. Patients who received RSI in the ED at Children’s Medical Center
3. Patients intubated between January 1, 1995 and January 1, 2008
4. Patients intubated with an endotracheal tube or laryngeal mask airway
5. Patients where intubation was attempted in the ED, but subsequently required operating
room (OR) airway management