Peri-Intubation Arrest in High Risk vs. Standard Risk Pediatric Trauma Patients Undergoing Endotracheal Intubation

Area of Science:

• Pediatric Emergency Medicine
• Trauma Critical Care
• Airway Management

Background:

• Difficult airway management in pediatric trauma is a significant concern.
• Physiologic risk factors for difficult airways are less understood in pediatric trauma compared to medical patients.
• This study evaluates established high-risk physiologic criteria in a pediatric trauma population.

Purpose of the Study:

• To determine if previously identified high-risk physiologic criteria for difficult airways in medical patients are associated with adverse outcomes in pediatric trauma patients.
• To assess the impact of specific physiologic risk factors on peri-intubation and in-hospital adverse events.
• To evaluate the association between the number of risk factors and the incidence of cardiac arrest.

Main Methods:

• Retrospective chart review of pediatric patients (≤18 years) undergoing endotracheal intubation (EI) in a pediatric emergency department (2016-2021).
• Evaluation of high-risk criteria: hypotension, cardiac dysfunction concern, persistent hypoxemia, severe metabolic acidosis (pH < 7.1), and post-return of spontaneous circulation.
• Primary outcome: peri-intubation cardiac arrest; secondary outcomes: in-hospital arrest, mortality, and first-pass EI success.

Main Results:

• 36.4% of 88 patients had at least one high-risk criterion.
• High-risk group showed significantly higher rates of peri-intubation arrest (28.1% vs. 0%), PED/in-hospital arrest (43.8% vs. 3.4%), and in-hospital mortality (33.4% vs. 3.6%).
• Increasing numbers of risk factors correlated with exponentially higher odds of post-intubation cardiac arrest (ORs ranging from 6.7 to 56.1).

Conclusions:

• High-risk physiologic criteria are significantly associated with increased peri-intubation arrest, in-hospital arrest, and mortality in pediatric trauma patients.
• The presence of multiple risk factors confers an incrementally higher risk of cardiac arrest following intubation.
• These findings underscore the importance of identifying and managing physiologic instability in pediatric trauma patients requiring airway intervention.