• Resuscitation · Sep 2023

    Multicenter Study Observational Study

    High-Risk Criteria for the Physiologically Difficult Paediatric Airway: a Multicenter, Observational Study to Generate Validity Evidence.

    • Preston Dean, Gary Geis, Erin F Hoehn, Andrew J Lautz, Katherine Edmunds, Ashish Shah, Yin Zhang, Mary Frey, Stephanie Boyd, Joshua Nagler, Kelsey A Miller, Tara L Neubrand, Natasha Cabrera, Tara M Kopp, Esper Wadih, Nirupama Kannikeswaran, Audrey VanDeWall, Elizabeth K Hewett Brumberg, Aaron Donoghue, Lauren Palladino, Karen J O'Connell, Malek Mazzawi, Derek Chi Fung Tam, Matthew Murray, and Benjamin Kerrey.
    • Division of Emergency Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, United States; Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, United States. Electronic address: preston.dean@cchmc.org.
    • Resuscitation. 2023 Sep 1; 190: 109875109875.

    BackgroundSingle-center studies have identified risk factors for peri-intubation cardiac arrest in the emergency department (ED). The study objective was to generate validity evidence from a more diverse, multicenter cohort of patients.MethodsWe completed a retrospective cohort study of 1200 paediatric patients who underwent tracheal intubation in eight academic paediatric EDs (150 per ED). The exposure variables were 6 previously studied high-risk criteria for peri-intubation arrest: (1) persistent hypoxemia despite supplemental oxygen, (2) persistent hypotension, (3) concern for cardiac dysfunction, (4) post-return of spontaneous circulation (ROSC), (5) severe metabolic acidosis (pH < 7.1), and (6) status asthmaticus. The primary outcome was peri-intubation cardiac arrest. Secondary outcomes included extracorporeal membrane oxygenation (ECMO) cannulation and in-hospital mortality. We compared all outcomes between patients that met one or more versus no high-risk criteria, using generalized linear mixed models.ResultsOf the 1,200 paediatric patients, 332 (27.7%) met at least one of 6 high-risk criteria. Of these, 29 (8.7%) suffered peri-intubation arrest compared to zero arrests in patients meeting none of the criteria. On adjusted analysis, meeting at least one high-risk criterion was associated with all 3 outcomes - peri-intubation arrest (AOR 75.7, 95% CI 9.7-592.6), ECMO (AOR 7.1, 95% CI 2.3-22.3) and mortality (AOR 3.4, 95% 1.9-6.2). Four of 6 criteria were independently associated with peri-intubation arrest: persistent hypoxemia despite supplemental oxygen, persistent hypotension, concern for cardiac dysfunction, and post-ROSC.ConclusionsIn a multicenter study, we confirmed that meeting at least one high-risk criterion was associated with paediatric peri-intubation cardiac arrest and patient mortality.Copyright © 2023 Elsevier B.V. All rights reserved.

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