Audrey De Jong1,2, Amélie Rolle1,3, Nicolas Molinari4, Catherine Paugam-Burtz5,6, Jean-Michel Constantin7, Jean-Yves Lefrant8, Karim Asehnoune9, Boris Jung2,10, Emmanuel Futier7, Gérald Chanques1,2, Elie Azoulay11, Samir Jaber1,2. 1. Anesthesiology and Intensive Care, Anesthesia and Critical Care Department B, Saint Eloi Teaching Hospital, Unité INSERM U1046, Université Montpellier 1, Université Montpellier 2, Centre Hospitalier Universitaire Montpellier, Montpellier, France. 2. INSERM U1046, CNRS UMR 9214, Montpellier, France. 3. Department of Intensive Care & Anesthesiology, University of Pointe à Pitre Hospital. Guadeloupe, France. 4. Department of Statistics, University of Montpellier Lapeyronie Hospital, UMR 5149 IMAG, Montpellier, France. 5. Department of Intensive Care & Anesthesiology, University of Paris Diderot, Sorbonne Paris Cité, Paris, France. 6. AP-HP, Hôpital Beaujon, Paris, France. 7. Department of Intensive Care & Anesthesiology, Hotel-Dieu Hospital, University Hospital of Clermont Ferrand, Clermont-Ferrand, France. 8. Department of Intensive Care & Anesthesiology, University of Montpellier, Nimes Hospital, Nimes, France. 9. Department of Intensive Care & Anesthesiology, University of Nantes, Hotel-Dieu Hospital, Nantes, France. 10. Medical Intensive Care Unit, Lapeyronie Teaching Hospital, Centre Hospitalier Universitaire Montpellier, Montpellier, France. 11. Medical Intensive Care Unit, University of Paris-Diderot, Saint Louis Hospital, Paris, France.
Abstract
OBJECTIVES: To determine the prevalence of and risk factors for cardiac arrest during intubation in ICU, as well as the association of ICU intubation-related cardiac arrest with 28-day mortality. DESIGN: Retrospective analysis of prospectively collected data. SETTING: Sixty-four French ICUs. PATIENTS: Critically ill patients requiring intubation in the ICU. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: During the 1,847 intubation procedures included, 49 cardiac arrests (2.7%) occurred, including 14 without return of spontaneous circulation (28.6%) and 35 with return of spontaneous circulation (71.4%). In multivariate analysis, the main predictors of intubation-related cardiac arrest were arterial hypotension (systolic blood pressure < 90 mm Hg) prior to intubation (odds ratio = 3.406 [1.797-6.454]; p = 0.0002), hypoxemia prior to intubation (odds ratio = 3.991 [2.101-7.583]; p < 0.0001), absence of preoxygenation (odds ratio = 3.584 [1.287-9.985]; p = 0.0146), overweight/obesity (body mass index > 25 kg/m; odds ratio = 2.005 [1.017-3.951]; p = 0.0445), and age more than 75 years old (odds ratio = 2.251 [1.080-4.678]; p = 0.0297). Overall 28-day mortality rate was 31.2% (577/1,847) and was significantly higher in patients who experienced intubation-related cardiac arrest than in noncardiac arrest patients (73.5% vs 30.1%; p < 0.001). After multivariate analysis, intubation-related cardiac arrest was an independent risk factor for 28-day mortality (hazard ratio = 3.9 [2.4-6.3]; p < 0.0001). CONCLUSIONS:ICU intubation-related cardiac arrest occurs in one of 40 procedures with high immediate and 28-day mortality. We identified five independent risk factors for cardiac arrest, three of which are modifiable, possibly to decrease intubation-related cardiac arrest prevalence and 28-day ICU mortality.
RCT Entities:
OBJECTIVES: To determine the prevalence of and risk factors for cardiac arrest during intubation in ICU, as well as the association of ICU intubation-related cardiac arrest with 28-day mortality. DESIGN: Retrospective analysis of prospectively collected data. SETTING: Sixty-four French ICUs. PATIENTS: Critically illpatients requiring intubation in the ICU. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: During the 1,847 intubation procedures included, 49 cardiac arrests (2.7%) occurred, including 14 without return of spontaneous circulation (28.6%) and 35 with return of spontaneous circulation (71.4%). In multivariate analysis, the main predictors of intubation-related cardiac arrest were arterial hypotension (systolic blood pressure < 90 mm Hg) prior to intubation (odds ratio = 3.406 [1.797-6.454]; p = 0.0002), hypoxemia prior to intubation (odds ratio = 3.991 [2.101-7.583]; p < 0.0001), absence of preoxygenation (odds ratio = 3.584 [1.287-9.985]; p = 0.0146), overweight/obesity (body mass index > 25 kg/m; odds ratio = 2.005 [1.017-3.951]; p = 0.0445), and age more than 75 years old (odds ratio = 2.251 [1.080-4.678]; p = 0.0297). Overall 28-day mortality rate was 31.2% (577/1,847) and was significantly higher in patients who experienced intubation-related cardiac arrest than in noncardiac arrestpatients (73.5% vs 30.1%; p < 0.001). After multivariate analysis, intubation-related cardiac arrest was an independent risk factor for 28-day mortality (hazard ratio = 3.9 [2.4-6.3]; p < 0.0001). CONCLUSIONS: ICU intubation-related cardiac arrest occurs in one of 40 procedures with high immediate and 28-day mortality. We identified five independent risk factors for cardiac arrest, three of which are modifiable, possibly to decrease intubation-related cardiac arrest prevalence and 28-day ICU mortality.
Authors: Jonathan D Casey; David R Janz; Derek W Russell; Derek J Vonderhaar; Aaron M Joffe; Kevin M Dischert; Ryan M Brown; Aline N Zouk; Swati Gulati; Brent E Heideman; Michael G Lester; Alexandra H Toporek; Itay Bentov; Wesley H Self; Todd W Rice; Matthew W Semler Journal: N Engl J Med Date: 2019-02-18 Impact factor: 91.245
Authors: Vincenzo Russotto; Sheila Nainan Myatra; John G Laffey; Elena Tassistro; Laura Antolini; Philippe Bauer; Jean Baptiste Lascarrou; Konstanty Szuldrzynski; Luigi Camporota; Paolo Pelosi; Massimiliano Sorbello; Andy Higgs; Robert Greif; Christian Putensen; Christina Agvald-Öhman; Athanasios Chalkias; Kristaps Bokums; David Brewster; Emanuela Rossi; Roberto Fumagalli; Antonio Pesenti; Giuseppe Foti; Giacomo Bellani Journal: JAMA Date: 2021-03-23 Impact factor: 56.272