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Risk factors associated with inpatient cardiac arrest during emergency endotracheal intubation at general wards

Chul Park1

  • 1Division of Pulmonary Medicine, Department of Internal Medicine, Wonkwang University Hospital, Iksan, Korea.

Acute and Critical Care
|November 15, 2019
PubMed

Insights

Peri-intubation cardiac arrest (PICA) is a rare complication of emergent endotracheal intubation (ETI). Key risk factors include shock index, intubation attempts, and vasopressor/neuromuscular blocking agent use.

Area of Science:

  • Critical Care Medicine
  • Anesthesiology
  • Emergency Medicine

Background:

  • Peri-intubation cardiac arrest (PICA) is a rare but preventable complication of emergent endotracheal intubation (ETI).
  • Limited data exist on factors associated with inpatient PICA and patient outcomes.
  • This study aimed to identify risk factors for PICA in hospitalized patients and compare outcomes with other inpatient cardiac arrests (OTICA).

Purpose of the Study:

  • Identify risk factors for PICA in hospitalized patients undergoing emergent ETI.
  • Compare clinical outcomes between PICA and OTICA.

Main Methods:

  • Retrospective observational study at two institutions (January 2016 - December 2017).
  • PICA defined as cardiac arrest within 20 minutes post-ETI in emergent intubations.
  • Risk factors identified via logistic regression; outcomes compared between PICA and OTICA.

Main Results:

  • Fifteen PICA episodes occurred (3.6% of inpatient arrests).
  • Independent risk factors for PICA included shock index, intubation attempts, pre-ETI vasopressor use, and neuromuscular blocking agent (NMBA) use (especially succinylcholine).
  • No significant differences in ICU/hospital length of stay, survival, or neurologic outcomes between PICA and OTICA.

Conclusions:

  • Four independent risk factors for PICA were identified.
  • Preintubation hemodynamic stabilization and avoiding NMBAs may reduce PICA risk.
  • Clinical outcomes for PICA were similar to other inpatient cardiac arrests.
Abstract

Keywords:
endotracheal intubationheart arrestneuromuscular blocking agentrisk factorshock

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