Acute Crit Care.  2019 Aug;34(3):212-218. 10.4266/acc.2019.00598.

Risk factors associated with inpatient cardiac arrest during emergency endotracheal intubation at general wards

• Park C

• KMID: 2457679
• DOI: http://doi.org/10.4266/acc.2019.00598

Abstract

BACKGROUND
Peri-intubation cardiac arrest (PICA) following emergent endotracheal intubation (ETI) is a rare, however, potentially preventable type of cardiac arrest. Limited published data have described factors associated with inpatient PICA and patient outcomes. The aim of this study was to identify risk factors associated with PICA among hospitalized patients emergently intubated at a general ward as compared to non-PICA inpatients. In addition, we identified a difference of clinical outcomes in patients between PICA and other types of inpatient cardiac arrest (OTICA).
METHODS
We conducted a retrospective observational study of patients at two institutions between January 2016 to December 2017. PICA was defined in patients emergently intubated who experienced cardiac arrest within 20 minutes after ETI. The non-PICA group consisted of inpatients emergently intubated without cardiac arrest. Risk factors for PICA were identified through univariate and multivariate logistic regression analysis. Clinical outcomes were compared between PICA and OTICA.
RESULTS
Fifteen episodes of PICA occurred during the study period, accounting for 3.6% of all inpatient arrests. Intubation-related shock index, number of intubation attempts, pre-ETI vasopressor use, and neuromuscular blocking agent (NMBA) use, especially succinylcholine, were independently associated with PICA. Clinical outcomes of intensive care unit and hospital length of stay, survival to discharge, and neurologic outcome at hospital discharge were not significantly different between PICA and OTICA.
CONCLUSIONS
We identified four independent risk factors for PICA, and preintubation hemodynamic stabilization and avoidance of NMBA were possibly correlated with a decreased PICA risk. Clinical outcomes of PICA were similar to those of OTICA.

Keyword

endotracheal intubation; heart arrest; neuromuscular blocking agent; risk factor; shock

MeSH Terms

Emergencies*
Heart Arrest*
Hemodynamics
Humans
Inpatients*
Intensive Care Units
Intubation
Intubation, Intratracheal*
Length of Stay
Logistic Models
Neuromuscular Blockade
Observational Study
Patients' Rooms*
Pica
Retrospective Studies
Risk Factors*
Shock
Succinylcholine
Succinylcholine

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