A Modern and Practical Review of Rapid-Sequence Intubation in Pediatric Emergencies

Rapid-sequence intubation is the standard for definitive airway management in the emergency department and requires multiple stepwise tasks where the sequence and timing are important. Optimal performance of this critical procedure can be challenging, and common pitfalls exist that emergency providers may encounter when performing rapid-sequence intubation in children. Prolonged and/or failed endotracheal intubation attempts and adverse effects are not infrequent, especially in neonates and young children. Formal standardization of the approach and use of technological advances in intubation and monitoring equipment can decrease variation in the process, improve team-level situational awareness, and mitigate risk to the patient. This article reviews the required planning and preparatory steps, and offers specific strategies aimed at mitigating the associated risks and potential pitfalls to enhance the likelihood of success and safety during the performance of this high-risk procedure in children.