• Gabriel Wardi, Julian Villar, Thien Nguyen, Anuja Vyas, Nicholas Pokrajac, Anushirvan Minokadeh, Daniel Lasoff, Christopher Tainter, Jeremy R Beitler, and Rebecca E Sell.
• Department of Emergency Medicine and Division of Pulmonary, Critical Care, and Sleep Medicine, UC San Diego Health System, U S. Electronic address: gwardi@ucsd.edu.
• Resuscitation. 2017 Dec 1; 121: 76-80.

BackgroundInpatient peri-intubation cardiac arrest (PICA) following emergent endotracheal intubation (ETI) is an uncommon but potentially preventable type of cardiac arrest (CA). Limited published data exist describing factors associated with inpatient PICA and patient outcomes. This study identifies risk factors associated with PICA among hospitalized patients emergently intubated out of the operating room and compares PICA to other types of inpatient CA.MethodsRetrospective case-control study of patients at our institution over a five-year period. Cases were defined as inpatients emergently intubated outside of the operating room that experienced cardiac arrest within 20min after ETI. The control group consisted of inpatients emergently intubated out of the operating room without CA. Predictors of PICA were identified through univariate and multivariate analysis. Clinical outcomes were compared between PICA and other inpatient CAs, identified through a prospectively enrolled CA registry at our institution.Results29 episodes of PICA occurred over 5 years, accounting for 5% of all inpatient arrests. Shock index ≥1.0, intubation within one hour of nursing shift change, and use of succinylcholine were independently associated with PICA. Sustained ROSC, survival to discharge, and neurocognitive outcome did not differ significantly between groups.ConclusionPatients outcomes following PICA were comparable to other causes of inpatient CA. Potentially modifiable factors were associated with PICA. Hemodynamic resuscitation, optimized staffing strategies, and possible avoidance of succinylcholine were associated with decreased risk of PICA. Clinical trials testing targeted strategies to optimize peri-intubation care are needed to identify effective interventions to prevent this potentially avoidable type of CA.Copyright © 2017 Elsevier B.V. All rights reserved.

24 keywords...

hide…