How to Identify Patients at High Risk for Cardiac Arrest with Intubation
Research By: Preston Dean, MD, MS | Gary Geis, MD
Post Date: September 1, 2023 | Publish Date: September 2023
Emergency Medicine | Top Scientific Achievement
An analysis of 1,200 children receiving intubation at eight Level 1 pediatric trauma centers in the United States has confirmed multiple criteria that emergency caregivers can use to identify patients at high risk of cardiac arrest with intubation.
The retrospective cohort study, led by Preston Dean, MD, MS, and Gary Geis, MD, at Cincinnati Children’s, reviewed 150 recent patient encounters at each participating center. It included data about the reasons for intubation, the experience levels of those performing first attempts, and whether the patients met any of six high-risk criteria for cardiac arrest.
Overall, cardiac arrest occurred in 29 patients. All of the patients that suffered cardiac arrest met at least one high-risk criterion, while none of the 868 patients without any high-risk criteria suffered an arrest. Four criteria were independently associated with peri-intubation arrest. In order of strength, they were: post-ROSC (return of spontaneous circulation), concern for cardiac dysfunction, persistent hypotension, and hypoxemia despite supplemental oxygen. Other than a previous single-center study conducted at Cincinnati Children’s, the co-authors say no other studies have evaluated post-ROSC as a risk factor for peri-intubation cardiac arrest.
“We believe that the risk of cardiac arrest can be mitigated in high-risk patients, especially with thoughtful evaluation and careful preparation,” Dean says. “Patients meeting one or more criteria must be identified before performing tracheal intubation.”
The research team’s recommendations include holding team-level discussions to determine risks and develop mitigation plans. Other strategies include directing first intubation attempts involving high-risk cases to the most experienced proceduralists, limiting the duration of attempts, using video laryngoscopes and providing vasoactive medications to hypotensive patients.
Cincinnati Children’s co-authors included Andrew Lautz, MD, Katherine Edmunds, MD, Yin Zhang, MS, Mary Frey, Stephanie Boyd, PhD, and Benjamin Kerrey, MD. Experts from from nine other pediatric hospitals also contributed.
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| Original title: | High-risk criteria for the physiologically difficult paediatric airway: A multicenter, observational study to generate validity evidence |
| Published in: | Resuscitation |
| Publish date: | September 2023 |
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