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Risk factors for peri-intubation cardiac arrest: A systematic review and meta-analysis

Ting-Hao Yang1, Shih-Chieh Shao2, Yi-Chih Lee1

  • 1Department of Emergency Medicine, Chang Gung Memorial Hospital at Linkou, Taoyuan, Taiwan.

Biomedical Journal
|September 3, 2023
PubMed

Insights

Peri-intubation cardiac arrest (PICA) is a serious complication. Key risk factors include pre-intubation hypotension, hypoxemia, and multiple intubation attempts, aiding in identifying high-risk patients.

Area of Science:

  • Critical Care Medicine
  • Anesthesiology
  • Cardiovascular Research

Background:

  • Peri-intubation cardiac arrest (PICA) is a rare but severe complication during tracheal intubation.
  • Previous studies on PICA risk factors have yielded inconsistent results.
  • This study systematically reviews and meta-analyzes risk factors associated with PICA.

Approach:

  • Searched MEDLINE and EMBASE for studies on PICA risk factors published before November 1, 2022.
  • Extracted and recorded adjusted or unadjusted odds ratios (ORs) and risk ratios (RRs).
  • Utilized a random-effects model for meta-analysis to identify statistically significant risk factors and assessed evidence certainty.

Key Points:

  • Pre-intubation hypotension significantly increases PICA risk (pooled OR: 4.96).
  • Pre-intubation hypoxemia is associated with a higher risk of PICA (pooled OR: 4.43).
  • Two or more intubation attempts elevate PICA risk (pooled OR: 1.88).
  • The pooled incidence of PICA was found to be 2.1%.

Conclusions:

  • Pre-intubation hypotension, hypoxemia, and multiple intubation attempts are significant risk factors for PICA.
  • These findings can assist clinicians in identifying patients at elevated risk in acute settings.
  • Understanding these risk factors is crucial for improving patient safety during intubation procedures.
Abstract

Keywords:
Airway managementCardiac arrestCritical careEndotracheal intubationPeri-intubation cardiac arrest

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