The Association of Teamwork and Adverse Tracheal Intubation–Associated Events (TIAEs) in Advanced Airway Management in the Pediatric ICU

Background: Tracheal intubation in critically ill children is a life-saving, but high-risk procedure that involves multiple team members with diverse clinical skills. We aim to examine the association between the provider-reported teamwork rating and the occurrence of adverse tracheal intubation–associated events (TIAEs). Methods: A retrospective analysis of prospectively collected data from 45 pediatric intensive care units (PICUs) in the National Emergency Airway Registry for Children (NEAR4KIDS) database from January 2013 to March 2018 was performed. A composite teamwork score was generated using the average of each of five (7-point Likert scale) domains in the teamwork assessment tool. Poor teamwork was defined as an average score of 4 or lower. Team provider stress data were also recorded with each intubation. Results: 12,536 tracheal intubations (TIs) were reported from 2013 to 2018. Approximately 4.1% (n=520) rated a poor teamwork score. TIs indicated for shock were more commonly associated with a poor teamwork score, while those indicated for procedures and those utilizing neuromuscular blockade were less commonly associated with a poor teamwork score. TIs with poor teamwork were associated with a higher occurrence of adverse TIAE (24.4% vs. 14.4%, p<0.001), severe TIAE (13.7% vs. 5.9%, p<0.001), and peri-intubation hypoxemia < 80% (26.4% vs. 17.9%, p<0.001). After adjusting for indication, provider type, and neuromuscular blockade use, poor teamwork was associated with higher odds of adverse TIAEs (OR 1.77, 95% CI 1.35-2.34), severe TIAEs (OR 2.23, 95% CI 1.47-3.37) and hypoxemia (OR 1.63, 95% CI 1.25-2.03). Conclusion: TIs with poor teamwork were independently associated with a higher occurrence of TIAEs, severe TIAEs, and hypoxemia.