Research Horizons


Risk Factors Confirmed for Pediatric Peri-Intubation Cardiac Arrest in Physiologically Difficult Airways

Emergency Medicine | Top Scientific Achievement
2023 Research Discoveries These six criteria indicate when children face increased risk of cardiac arrest following intubation, according to a multicenter study validating findings from an earlier single-site study.

For the first time, a study has provided strong, multi-center validation that six physiologic criteria raise the risk for peri-intubation cardiac arrest in pediatric patients. The findings build on earlier research that identified the criteria in a single-center study.

The current study—a retrospective cohort analysis—looked at 1,200 intubations in eight U.S. pediatric emergency departments. All were Level I trauma centers offering dedicated pediatric care. At each center, researchers collected data on the 150 most recent consecutive encounters with eligible patients. Median age of the children included was approximately 3.5 years. Of the 1,200 patients investigated, 332 met at least one high-risk criterion, which included:

  • Concern for cardiac dysfunction
  • Hypoxemia, despite supplemental oxygen
  • Persistent hypotension
  • Post-return of spontaneous circulation (post-ROSC)
  • Severe metabolic acidosis
  • Status asthmaticus

In total, 29 children experienced peri-intubation cardiac arrest, and all met at least one high-risk criterion. The more criteria met, the greater the risk of arrest. There were no peri-intubation cardiac arrests in the 868 children who met none of the high-risk criteria.

The most common high-risk criteria—hypoxemia despite supplemental oxygen, persistent hypotension and concern for cardiac dysfunction—matched those identified in the earlier, single-center study. These three criteria and post-ROSC were independently associated with peri-intubation cardiac arrest.

“Our findings point to the importance of identifying children who meet the high-risk criteria before intubation,” says corresponding author Preston Dean, MD, MS. “Optimizing hemodynamic status, having the most skilled provider perform the intubation, and consulting with critical care specialists when necessary is vitally important.”

Other Cincinnati Children’s experts involved in this research included Gary Geis, MD; Andrew Lautz, MD; Katherine Edmunds, MD, MEd; Yin Zhang, MS; Mary Frey, MSN, RN; Stephanie Boyd, PhD; and Benjamin Kerrey, MD.

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Publication Information
Original title: High-risk criteria for the physiologically difficult paediatric airway: A multicenter, observational study to generate validity evidence
Published in: Resuscitation
Publish date: June 14, 2023
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Research By

Preston Dean, MD, MS
Preston Dean, MD, MS
Division of Emergency Medicine
Gary Geis, MD
Gary Geis, MD
Medical Director, Center for Simulation and Research