Peri-intubation cardiac arrest in the Emergency Department: A National Emergency Airway Registry (NEAR) study
| Autor: | Lucienne Lutfy-Clayton, Michael D. April, Guy Shochat, Brian E. Driver, Calvin Brown rd, Shane M. Summers, Medley Gatewood, Benjamin J. Sandefur, Joshua J. Oliver, Ron M. Walls, William T. Davis, Megan L. Fix, Fred A. Severyn, Matthew Murray, Joshua C. Reynolds, Nicholas Lauerman, Bruce Hurley, Stephen Miller, Stacy A. Trent, Steven G. Schauer, Daniel Runde, Susan R. Wilcox, Allyson A. Arana, John Riordan, Brit Long, Matthew Hansen, Calvin A. Brown rd, Amy H. Kaji, J.N. Carlson, Jestin N. Carlson, Eugene Chan, Bob Kilgo, Margaret Nguyen |
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| Rok vydání: | 2021 |
| Předmět: |
medicine.medical_specialty
Adolescent medicine.medical_treatment 030204 cardiovascular system & hematology Emergency Nursing Hypoxemia 03 medical and health sciences 0302 clinical medicine Intubation Intratracheal medicine Humans Intubation Prospective Studies Registries business.industry Incidence (epidemiology) 030208 emergency & critical care medicine Emergency department Odds ratio Heart Arrest Blood pressure Shock (circulatory) Emergency medicine Emergency Medicine medicine.symptom Emergency Service Hospital Cardiology and Cardiovascular Medicine business Airway |
| Zdroj: | Resuscitation. 162:403-411 |
| ISSN: | 0300-9572 |
| Popis: | To determine the incidence of peri-intubation cardiac arrest through analysis of a multi-center Emergency Department (ED) airway registry and to report associated clinical characteristics.This is a secondary analysis of prospectively collected data (National Emergency Airway Registry) comprising ED endotracheal intubations (ETIs) of subjects14 years old from 2016 to 2018. We excluded those with cardiac arrest prior to intubation. The primary outcome was peri-intubation cardiac arrest. Multivariable logistic regression generated adjusted odds ratios (aOR) of variables associated with this outcome, controlling for clinical features, difficult airway characteristics, and ETI modality.Of 15,776 subjects who met selection criteria, 157 (1.0%, 95% CI 0.9-1.2%) experienced peri-intubation cardiac arrest. Pre-intubation systolic blood pressure100 mm Hg (aOR 6.2, 95% CI 2.5-8.5), pre-intubation oxygen saturation90% (aOR 3.1, 95% CI 2.0-4.8), and clinician-reported need for immediate intubation without time for full preparation (aOR 1.8, 95% CI, 1.2-2.7) were associated with higher likelihood of peri-intubation cardiac arrest. The association between pre-intubation shock and cardiac arrest persisted in additional modeling stratified by ETI indication, induction agent, and oxygenation status.Peri-intubation cardiac arrest for patients undergoing ETI in the ED is rare. Higher likelihood of arrest occurs in patients with pre-intubation shock or hypoxemia. Prospective trials are necessary to determine whether a protocol to optimize pre-intubation haemodynamics and oxygenation mitigates the risk of peri-intubation cardiac arrest. |
| Databáze: | OpenAIRE |
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