Pediatric Prehospital Ventilation Trial (Pedi-VENT) - The overall objective of this project is to conduct an in-depth analysis of pediatric prehospital emergency ventilation and identify a ventilation strategy associated with the best patient outcomes. Control of the airway and breathing is vitally important for children with a critical illness or injury treated in the Emergency Medical Services (EMS) system, though the best techniques are unknown. Ventilation delivery is a crucial component of prehospital resuscitation, ensuring adequate oxygen delivery to the brain and vital organs and appropriate clearance of C02 while minimizing the potential risks of overventilation, such as regurgitation and barotrauma. In EMS, clinicians typically use a self-inflating bag to give positive pressure ventilations, with manual control of the breath delivery. The existing data regarding the optimal ventilation rate for critically ill children treated in the EMS system is extremely limited, and current guidelines are based on expert consensus informed by small studies performed in hospitals. In this ancillary study, we will leverage the infrastructure of the Pedi-PART trial, an NHLBI-funded clinical trial carried out in the Pediatric Emergency Care Applied Research Network (PECARN). Pedi-PART compares pediatric airway management devices in over 60 EMS agencies. In the parent study, we will collect and archive physiologic data from the patient monitors used by these EMS agencies. In the proposed Pedi-VENT study, our team will apply sophisticated signal processing algorithms to the monitor data to determine the ventilation rate delivered by the EMS clinicians in the field. We will then apply target trial emulation methods to conduct analyses comparing pre-defined ventilation patterns based on the natural variability in current practice, similar to potential arms in a clinical trial. Though observational, our study will have the advantage of prospective data collection and standard definitions of exposure and outcomes with the parent trial infrastructure. The study aims are to 1) ETI) compare the effects of the airway strategy (BVM, SGA, on ventilation performance among critically ill children undergoing prehospital airway management, 2) examine the comparative effectiveness of different ventilation strategies on 30-day ICU-free survival, and 3) evaluate previous efficiently impact children how airway management strategies and ventilation trategies j ointly impact patient outcomes. No study has examined pediatric ventilation i n the EMS setting on this scale. We can conduct the study by leveraging an existing clinical rial led by members of our team. The results of this study will resuscitation guidelines for pediatric emergencies worldwide and help improve outcomes for critically ill treated in emergency care systems. s t
