Feasibility Trial of an Implementation Bundle for the National Emergency Airway Registry for Pediatric Emergency Medicine (NEAR4PEM) Pre-Intubation Checklist

Tracheal intubation (Tl) of critically ill children presenting to the emergency department after trauma is a lifesaving but challenging procedure. It has been found that about 18% of Tis in the pediatric emergency department (PED) are performed for trauma indications; between 15-30% of patients undergoing Tl in the PED experience adverse events and nearly one-third require multiple attempts. Pediatric trauma tracheal intubations (TTls) are particularly challenging due to lack of patient information, very little time to prepare, and rapid assembly of an ad hoc multidisciplinary team. There is currently no rigorously implemented checklist available for pediatric trauma tracheal intubations (TTls). Formed under the umbrella of the National Emergency Airway Registry for Kids (NEAR4KIDS, N4K), the National Emergency Airway Registry for Pediatric Emergency Medicine (NEAR4PEM, N4P) is a multicenter collaborative and prospective registry for advanced airway management in the PED. Using the robust infrastructure of N4K, including a data coordination center, we have developed a growing quality improvement research network, achieved high compliance for reporting Tl process of care and adverse Tl associated events (TIAEs), and described the landscape of patients, providers, and outcomes of Tl across 13 diverse PEDs. Additionally, to address the unique challenges of pediatric TTls, we recently developed a consensus-driven, evidence-based N4P Pre-Intubation Checklist using a multifaceted, rigorous approach. Recognizing that the use of an intubation checklist in the PED is a change in routine clinical care for many departments, we are currently creating a NEAR4PEM Intubation Checklist Bundle, which combines the Checklist with identified optimal implementation strategies and clinical outcomes data feedback. The objective of this study is to use the Exploration, Preparation, Implementation, Sustainment (EPIS) framework and Expert Recommendations for Implementing Change (ERIC) strategies to guide our implementation of the N4P PreIntubation Checklist utilizing the Bundle in a pilot cohort of three pediatric trauma centers. We will use mixed method analyses, including surveys, video review of a proportion of Tis (including all trauma Tis), and focus groups, to measure checklist adherence, acceptability, and fidelity, a necessary step prior to a fully powered implementation and dissemination trial.