Emergent endotracheal intubation associated cardiac arrest, risks, and emergency implications

Emergent endotracheal intubation (ETI)-related cardiac arrest (CA) is a life-threatening complication that is poorly documented. Definitions and risk factors for CA during or directly after emergent ETI have not been clearly established and may represent modifiable means of improving patient outcomes. We conducted a review of the literature to assess the incidence and risk factors associated with ETI-related CA in the Emergency Department (ED) as well as in the inpatient setting outside of the operating room. Retrospective studies demonstrated that ETI-related CA incidence was between 1.7% and 23% in both the ED and the inpatient setting. Pre-intubation hypoxemia, hypotension, Shock Index (SI), Body Mass Index, and age were most associated with CA. Medications used for induction and number of attempts were identified as risk factors. Definitions of ETI-related CA also varied considerably ranging from within 5 min to within 60 min of intubation; however, the majority of ETI-related CA cases occurred within 10 min. Hemodynamic factors such as SI, hypotension, and hypoxemia were associated with increased rates of CA. ETI-related CA may represent a potentially modifiable complication that can improve patient outcomes in critically ill patients presenting in the ED.