Peri-intubation Cardiovascular Collapse During Emergency Airway Management

Emergency airway management is a lifesaving procedure but can be associated with significant risks, including hypoxia, hypotension, cardiac arrest, and death. Peri-intubation hypotension, reported in ≥ 40% of cases, is strongly associated with increased morbidity and mortality. While clinical guidelines emphasize the importance of preoxygenation and hemodynamic optimization prior to intubation, the latter remains poorly defined, with limited available data to guide evidence-based strategies to mitigate cardiovascular collapse during rapid sequence intubation. This review synthesizes current knowledge on the epidemiology, risk factors, and pathophysiology of peri-intubation hemodynamic deterioration. We review targeted strategies for hemodynamic optimization of physiologic parameters before intubation. These include volume expansion with fluid resuscitation, vasopressor utilization, selection of pharmacologic agents, invasive hemodynamic monitoring, and advanced preoxygenation techniques. In selected high-risk patients, we also discuss the potential role of extracorporeal membrane oxygenation as an adjunctive or rescue therapy. Our goal is to provide airway specialists with a comprehensive framework for mitigating cardiovascular collapse during emergent airway management and to stimulate further research into this high-risk and understudied domain.