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Risk Factors of Peri-Intubation Cardiac Arrest in Critically Ill Patients Presenting to the Emergency Department of a

Noman Ali1, Nazir Najeeb Kapadia2, Salman Muhammad Soomar3

  • 1Department of Emergency Medicine, Aga Khan University Hospital, Karachi, Pakistan.

The Journal of Emergency Medicine
|August 18, 2025
PubMed

Insights

Peri-intubation cardiac arrest is predicted by a high modified shock index, elevated lactate, low pH, hypoxemia, septic shock, and cardiogenic pulmonary edema. Early intervention targeting these risk factors is crucial for prevention.

Area of Science:

  • Emergency Medicine
  • Critical Care
  • Anesthesiology

Background:

  • Peri-intubation cardiac arrest occurs in 0.5%–4.2% of cases, associated with hypotension, hypoxemia, acidosis, and shock index.
  • Knowledge gaps exist regarding laboratory predictors and the modified shock index's value in predicting peri-intubation cardiac arrest.

Purpose of the Study:

  • Identify risk factors for peri-intubation cardiac arrest in Emergency Department patients requiring emergent airway protection.
  • Evaluate the predictive value of pre-intubation modified shock index.

Main Methods:

  • Matched case-control study (1:4 ratio) of adult patients undergoing emergency airway management.
  • Data collected from January 2019 to December 2022.
  • Multivariable logistic regression analysis to identify significant risk factors.

Main Results:

  • Modified shock index ≥ 1.3 (OR 5.61), lactic acid ≥ 2 mmol/L (OR 4.24), pH < 7.30 (OR 2.58), and PaO2 < 55 mmHg (OR 5.13) predicted cardiac arrest.
  • Septic shock (OR 5.76) and cardiogenic pulmonary edema (OR 5.76) were also significant predictors.

Conclusions:

  • Pre-intubation modified shock index, acidosis, hypoxemia, septic shock, and cardiogenic pulmonary edema are key predictors of peri-intubation cardiac arrest.
  • Therapeutic interventions targeting these identified risk factors are essential for prevention.
Abstract

Keywords:
case-control studyemergency departmentlow-income countryperi-intubation cardiac arrestrisk factors

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