Treating Respiratory Emergencies in Children Study (T-RECS): a pilot trial of prehospital treatment for life-threatening pediatric asthma

Objectives: The Treating Respiratory Emergencies in Children Study (T-RECS) pilot study evaluated the feasibility of a prehospital treatment protocol for life-threatening pediatric asthma, including combined albuterol/ipratropium (DuoNeb) and dexamethasone with a checklist, to inform a future trial. Methods: Prospective, before-and-after study across three US EMS agencies (January 2024-February 2025). We enrolled patients aged 2–17 with severe asthma exacerbations who met specific criteria. The intervention phase introduced the new protocol and checklist. The primary outcome was the hospital admission status collection rate. Secondary outcomes included NIH PROMIS asthma impact score collection, hospital-free days, and ICU-free days. Implementation outcomes were assessed using the RE-AIM framework, including reach, paramedic adoption, and protocol implementation. Paramedic surveys assessed protocol and checklist acceptability. The study was registered on clinicaltrials.gov on 8/10/23 (NCT06074185). Results: The study screened 302 patients and enrolled 43. Hospital admission status was collected for 58% of enrolled patients. There was an observed increase in the use of albuterol/ipratropium (50% to 78.1%) and dexamethasone (41.7% to 65.6%) in the post-intervention phase, with an increase in the combined use of both (16.7% to 53.1%). Paramedic surveys (28% response rate) indicated the protocol was generally easy to follow, and the checklist was helpful. Challenges included time constraints and specific eligibility criteria. Conclusions: This pilot trial evaluated the feasibility and acceptability of implementing a prehospital protocol for severe pediatric asthma. While hospital data collection needs to be improved, these findings provide important considerations for a larger trial to evaluate the impact of this intervention on patient outcomes.