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Area of Science:

  • Pediatric Critical Care Medicine
  • Resuscitation Science
  • Airway Management

Background:

  • Optimal airway management during pediatric in-hospital cardiac arrest (IHCA) remains unclear.
  • Intubation practices during pediatric IHCA have evolved over time.

Purpose of the Study:

  • To analyze trends in endotracheal intubation during pediatric IHCA from 2000-2022.
  • To determine the association between intra-arrest intubation and survival in a recent pediatric IHCA cohort (2017-2022).

Main Methods:

  • Retrospective cohort study using the Get With The Guidelines-Resuscitation registry (2000-2022).
  • Time-dependent propensity score matching and mixed-effects logistic regression were used to analyze the association between intra-arrest intubation and survival.
  • Subgroup analyses were performed based on age and illness category.

Main Results:

  • The overall intubation rate during pediatric IHCA decreased from 84.6% in 2000 to 66.7% in 2022.
  • In the 2017-2022 cohort, intra-arrest intubation was not associated with hospital survival after propensity score matching (aOR, 1.18; P=.23).
  • However, in children aged 8 years or older, intra-arrest intubation was associated with increased odds of discharge survival (aOR, 1.91; P=.02).

Conclusions:

  • Intra-arrest tracheal intubation was not associated with hospital survival in pediatric IHCA patients after matching, except for older children (8+ years).
  • These findings suggest a potential benefit of intubation in older pediatric patients experiencing IHCA.
  • Further research is warranted to explore the mechanisms underlying these associations.