• Akira Nishisaki, Ron W Reeder, Elizabeth Laverriere McGovern, Tageldin Ahmed, Michael J Bell, Robert Bishop, Matthew Bochkoris, Candice Burns, Joseph A Carcillo, Todd C Carpenter, Wesley Diddle, Myke Federman, Ericka L Fink, Deborah Franzon, Aisha H Frazier, Stuart H Friess, Kathryn Graham, Mark Hall, David A Hehir, Christopher M Horvat, Leanna L Huard, Tensing Maa, Arushi Manga, Patrick McQuillen, Kathleen L Meert, Ryan W Morgan, Peter M Mourani, Vinay M Nadkarni, Maryam Y Naim, Daniel Notterman, Chella A Palmer, Anil Sapru, Carleen Schneiter, Matthew P Sharron, Neeraj Srivastava, Shirley Viteri, David Wessel, Heather A Wolfe, Andrew R Yates, Athena F Zuppa, Robert M Sutton, and Robert A Berg.
• Department of Anesthesiology and Critical Care Medicine, The Children's Hospital of Philadelphia, University of Pennsylvania, Philadelphia, PA, USA. nishisaki@chop.edu.
• Crit Care. 2024 Aug 30; 28 (1): 286286.

BackgroundTracheal intubation (TI)-associated cardiac arrest (TI-CA) occurs in 1.7% of pediatric ICU TIs. Our objective was to evaluate resuscitation characteristics and outcomes between cardiac arrest patients with and without TI-CA.MethodsSecondary analysis of cardiac arrest patients in both ICU-RESUS trial and ancillary CPR-NOVA study. The primary exposure was TI-CA, defined as cardiac arrest occurred during TI procedure or within 20 min after endotracheal tube placement. The primary outcome was survival to hospital discharge with favorable neurological outcome (Pediatric Cerebral Performance Category score 1-3 or unchanged).ResultsAmong 315 children with cardiac arrests, 48 (15.2%) met criteria for TI-CA. Pre-existing medical conditions were similar between groups. Pre-arrest non-invasive mechanical ventilation was more common among TI-CA patients (18/48, 37.5%) compared to non-TI-CA patients (35/267, 13.1%). In 48% (23/48), the TI-CA occurred within 20 min after intubation (i.e., not during intubation). Duration of CPR was longer in TI-CA patients (median 11.0 min, interquartile range [IQR]: 2.5, 35.5) than non-TI-CA patients (median 5.0 min, IQR 2.0, 21.0), p = 0.03. Return of spontaneous circulation occurred in 32/48 (66.7%) TI-CA versus 186/267 (69.7%) non-TI-CA, p = 0.73. Survival to hospital discharge with favorable neurological outcome occurred in 29/48 (60.4%) TI-CA versus 146/267 (54.7%) non-TI-CA, p = 0.53.ConclusionsFifteen percent of these pediatric ICU cardiac arrests were associated with TI. Half of TI-CA occurred after endotracheal tube placement. While duration of CPR was longer in TI-CA patients, there were no differences in unadjusted outcomes following TI-CA versus non-TI-CA.Trial RegistrationThe ICU-RESUS (ClinicalTrials.gov Identifier: NCT02837497).© 2024. The Author(s).

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