Gabriel Wardi1, Julian Villar2, Thien Nguyen3, Anuja Vyas4, Nicholas Pokrajac5, Anushirvan Minokadeh6, Daniel Lasoff7, Christopher Tainter8, Jeremy R Beitler9, Rebecca E Sell10. 1. Department of Emergency Medicine and Division of Pulmonary, Critical Care, and Sleep Medicine, UC San Diego Health System, U S. Electronic address: gwardi@ucsd.edu. 2. Division of Pulmonary and Critical Care Medicine, Stanford University, 900 Welch Road, Suite 350, Palo Alto, CA 94304, U S. Electronic address: Julian.villar.nieves@gmail.com. 3. Department of Emergency Medicine, University of California, UC San Diego Health System, 200 W. Arbor Drive, San Diego, CA 92103, U S. Electronic address: thn030@ucsd.edu. 4. Sharp Health Care, 12710 Carmel Country Road, San Diego, CA 92130, U S. Electronic address: anuja.vyas@sharp.com. 5. Department of Emergency Medicine, University of California, UC San Diego Health System, 200 W. Arbor Drive, San Diego, CA 92103, U S. Electronic address: npokrajac@ucsd.edu. 6. Department of Anesthesiology, Division of Anesthesia Critical Care and Department of Emergency Medicine, UC San Diego Health System, 200 W. Arbor Drive, San Diego, CA 92103, U S. Electronic address: aminokadeh@ucsd.edu. 7. Department of Emergency Medicine, University of California, UC San Diego Health System, 200 W. Arbor Drive, San Diego, CA 92103, U S. Electronic address: dannylasoff@gmail.com. 8. Department of Anesthesiology, Division of Anesthesia Critical Care and Department of Emergency Medicine, UC San Diego Health System, 200 W. Arbor Drive, San Diego, CA 92103, U S. Electronic address: kittainter@gmail.com. 9. Division of Pulmonary, Critical Care Medicine, and Sleep Medicine, UC San Diego Health System, 200 West Arbor Drive, San Diego, CA 92103, U S. Electronic address: jbeitler@ucsd.edu. 10. Division of Pulmonary, Critical Care Medicine, and Sleep Medicine, UC San Diego Health System, 200 West Arbor Drive, San Diego, CA 92103, U S. Electronic address: rsell@ucsd.edu.
Abstract
BACKGROUND: Inpatient peri-intubation cardiac arrest (PICA) following emergent endotracheal intubation (ETI) is an uncommon but potentially preventable type of cardiac arrest (CA). Limited published data exist describing factors associated with inpatient PICA and patient outcomes. This study identifies risk factors associated with PICA among hospitalized patients emergently intubated out of the operating room and compares PICA to other types of inpatient CA. METHODS: Retrospective case-control study of patients at our institution over a five-year period. Cases were defined as inpatients emergently intubated outside of the operating room that experienced cardiac arrest within 20min after ETI. The control group consisted of inpatients emergently intubated out of the operating room without CA. Predictors of PICA were identified through univariate and multivariate analysis. Clinical outcomes were compared between PICA and other inpatient CAs, identified through a prospectively enrolled CA registry at our institution. RESULTS: 29 episodes of PICA occurred over 5 years, accounting for 5% of all inpatient arrests. Shock index ≥1.0, intubation within one hour of nursing shift change, and use of succinylcholine were independently associated with PICA. Sustained ROSC, survival to discharge, and neurocognitive outcome did not differ significantly between groups. CONCLUSION: Patients outcomes following PICA were comparable to other causes of inpatient CA. Potentially modifiable factors were associated with PICA. Hemodynamic resuscitation, optimized staffing strategies, and possible avoidance of succinylcholine were associated with decreased risk of PICA. Clinical trials testing targeted strategies to optimize peri-intubation care are needed to identify effective interventions to prevent this potentially avoidable type of CA.
BACKGROUND: Inpatient peri-intubation cardiac arrest (PICA) following emergent endotracheal intubation (ETI) is an uncommon but potentially preventable type of cardiac arrest (CA). Limited published data exist describing factors associated with inpatient PICA and patient outcomes. This study identifies risk factors associated with PICA among hospitalized patients emergently intubated out of the operating room and compares PICA to other types of inpatient CA. METHODS: Retrospective case-control study of patients at our institution over a five-year period. Cases were defined as inpatients emergently intubated outside of the operating room that experienced cardiac arrest within 20min after ETI. The control group consisted of inpatients emergently intubated out of the operating room without CA. Predictors of PICA were identified through univariate and multivariate analysis. Clinical outcomes were compared between PICA and other inpatient CAs, identified through a prospectively enrolled CA registry at our institution. RESULTS: 29 episodes of PICA occurred over 5 years, accounting for 5% of all inpatient arrests. Shock index ≥1.0, intubation within one hour of nursing shift change, and use of succinylcholine were independently associated with PICA. Sustained ROSC, survival to discharge, and neurocognitive outcome did not differ significantly between groups. CONCLUSION:Patients outcomes following PICA were comparable to other causes of inpatient CA. Potentially modifiable factors were associated with PICA. Hemodynamic resuscitation, optimized staffing strategies, and possible avoidance of succinylcholine were associated with decreased risk of PICA. Clinical trials testing targeted strategies to optimize peri-intubation care are needed to identify effective interventions to prevent this potentially avoidable type of CA.
Authors: Donald E G Griesdale; T Laine Bosma; Tobias Kurth; George Isac; Dean R Chittock Journal: Intensive Care Med Date: 2008-07-05 Impact factor: 17.440
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