Prehospital paediatric and neonatal ventilatory support by a South African public emergency medical service: A retrospective descriptive study

Background. Paediatric respiratory emergencies constitute a significant healthcare burden in low- and middle-income countries, yet prehospital ventilatory support practices remain poorly reported in these settings. Objective. To describe ventilatory support practices during interfacility transport and emergency responses by a public emergency medical service (EMS) for paediatric and neonatal patients in the Western Cape Province, South Africa (SA). Methods. This was a retrospective analysis of <5-year-old paediatric and neonatal patients receiving ventilatory support during transport by a public EMS in the Western Cape Province between January 2023 and December 2023. Electronic records were analysed for demographic information, clinical presentations, ventilation modalities, interventions and disposition using descriptive statistics, following STROBE reporting guidelines. Results. Among the 61 775 paediatric and neonatal EMS activations, 1 548 (2.5%) required ventilatory support. Interfacility transfers accounted for 1 539 (99.4%) cases, predominantly for respiratory distress (n=1 138, 73.5%). Non-invasive ventilation accounted for 1 255 (81.1%) cases, with nasal continuous positive airway pressure (nCPAP) the most used modality (n=1 030, 66.5%), followed by high-flow nasal cannula (n=225, 14.5%). Invasive ventilation was used in 293 (18.9%) cases. Infants aged 29 days - 12 months formed the largest age group (n=584, 37.7%), with neonates under 24 hours representing 26.0% (n=403). Vascular access was documented in 551 (35.6%) cases. Notably, a high FiO2 (>0.6) was documented in 119 (11.6%) nCPAP cases. A summary of the key findings is shown in Fig. 1. Conclusion. The study provides an important baseline description of ventilatory support practices for paediatric and neonatal patients transported by a public EMS system in SA. Nasal CPAP was the most frequently documented modality, and the findings mainly reflect interfacility transport practice. Opportunities for quality improvement include documentation, monitoring, vascular access and optimisation of transport ventilatory support. Future prospective studies should evaluate patient outcomes and ventilation practices in greater detail.