- Design
- Multicentre retrospective registry analysis
- Population
- 642 trainee-led intubations in children in US academic paediatric EDs
- Primary outcome
- First-attempt intubation success
- Effect
- EM residents 75%, PEM fellows 74%, paediatric residents 58% (aOR 0.41 vs EM)
A retrospective analysis of the NEAR4PEM registry, published in Annals of Emergency Medicine on 27 October 2026, examined 642 intubations of children in academic paediatric emergency departments from 2021 to 2023 where a trainee made the first attempt.
Overall first-attempt success was 73%. Emergency medicine residents (75%) and paediatric emergency medicine fellows (74%) did similarly, with no adjusted difference in success or adverse airway events. Paediatric residents, who made only 7% of first attempts, had lower first-attempt success (58%; adjusted OR 0.41, 95% CI 0.20 to 0.82) and more adverse airway outcomes (adjusted OR 2.14, 1.08 to 4.27) than emergency residents.
The pattern likely reflects procedural volume rather than specialty. It matters for who is given the first attempt in a sick child, and for how trainees with little airway exposure are supervised.
- Give the first attempt in paediatric intubation to the operator with the most recent airway experience.
- Supervise low-volume trainees directly, with a senior ready to take over.
- Use video laryngoscopy and a checklist to support trainee attempts.
- Track first-attempt success and desaturation locally to guide training.
Why it matters
Who makes the first attempt affects success and complications, and that choice is made in seconds.
Don't overread it
Observational registry data from academic centres; the paediatric resident group was small.
The statistics, in plain English
An adjusted odds ratio of 0.41 means substantially lower odds of first-pass success, but with only 45 paediatric resident attempts the interval (0.20 to 0.82) is wide.
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