Hemodynamic Collapse After Intubation in Critical Care Transport

Area of Science:

• Critical Care Medicine
• Emergency Medicine
• Transport Medicine

Background:

• Post-intubation hemodynamic collapse is a critical complication.
• Identifying modifiable risk factors is crucial for improving patient outcomes during transport.

Purpose of the Study:

• To determine the incidence of post-intubation hemodynamic collapse.
• To identify modifiable risk factors associated with this complication in critical care transport.

Main Methods:

• Retrospective chart review of 333 adult patients intubated by a critical care transport team.
• Primary outcome: incidence of hemodynamic collapse defined by specific blood pressure, vasopressor, and cardiac arrest criteria.
• Secondary outcomes: association of collapse with pre-intubation shock index, heart rate, blood pressure, and induction agent.

Main Results:

• Hemodynamic collapse occurred in 29.1% of patients; life-threatening collapse in 10.8%.
• Pre-intubation shock index >1 was significantly associated with post-intubation hemodynamic collapse (OR 3.18).
• Induction agent, fluid bolus, location, trauma, and age were not correlated with collapse risk.

Conclusions:

• Post-intubation hemodynamic collapse is frequent in critical care transport.
• A pre-intubation shock index >1 is a significant predictor of hemodynamic collapse.
• Further research may focus on proactive management of patients with elevated shock index prior to intubation.