Peri-intubation cardiac arrest in the Emergency Department: A National Emergency Airway Registry (NEAR) study
To determine the incidence of peri-intubation cardiac arrest through analysis of a multi-center Emergency Department (ED) airway registry and to report associated clinical characteristics. This is a secondary analysis of prospectively collected data (National Emergency Airway Registry) comprising ED...
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| Veröffentlicht in: | Resuscitation 2021-05, Vol.162, p.403-411 |
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| creator | April, Michael D. Arana, Allyson Reynolds, Joshua C. Carlson, Jestin N. Davis, William T. Schauer, Steven G. Oliver, Joshua J. Summers, Shane M. Long, Brit Walls, Ron M. Brown, Calvin A. Brown, Calvin April, Michael D. Carlson, Jestin Chan, Eugene Driver, Brian Fix, Megan Gatewood, Medley Hansen, Matthew Hurley, Bruce Kaji, Amy Kilgo, Bob Lauerman, Nicholas Lutfy-Clayton, Lucienne Miller, Stephen Murray, Matthew Nguyen, Margaret Riordan, John Runde, Daniel Sandefur, Benjamin Severyn, Fred Shochat, Guy Trent, Stacy Wilcox, Susan |
| description | To determine the incidence of peri-intubation cardiac arrest through analysis of a multi-center Emergency Department (ED) airway registry and to report associated clinical characteristics.
This is a secondary analysis of prospectively collected data (National Emergency Airway Registry) comprising ED endotracheal intubations (ETIs) of subjects >14 years old from 2016 to 2018. We excluded those with cardiac arrest prior to intubation. The primary outcome was peri-intubation cardiac arrest. Multivariable logistic regression generated adjusted odds ratios (aOR) of variables associated with this outcome, controlling for clinical features, difficult airway characteristics, and ETI modality.
Of 15,776 subjects who met selection criteria, 157 (1.0%, 95% CI 0.9–1.2%) experienced peri-intubation cardiac arrest. Pre-intubation systolic blood pressure |
| doi_str_mv | 10.1016/j.resuscitation.2021.02.039 |
| format | Article |
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This is a secondary analysis of prospectively collected data (National Emergency Airway Registry) comprising ED endotracheal intubations (ETIs) of subjects >14 years old from 2016 to 2018. We excluded those with cardiac arrest prior to intubation. The primary outcome was peri-intubation cardiac arrest. Multivariable logistic regression generated adjusted odds ratios (aOR) of variables associated with this outcome, controlling for clinical features, difficult airway characteristics, and ETI modality.
Of 15,776 subjects who met selection criteria, 157 (1.0%, 95% CI 0.9–1.2%) experienced peri-intubation cardiac arrest. Pre-intubation systolic blood pressure <100 mm Hg (aOR 6.2, 95% CI 2.5–8.5), pre-intubation oxygen saturation <90% (aOR 3.1, 95% CI 2.0−4.8), and clinician-reported need for immediate intubation without time for full preparation (aOR 1.8, 95% CI, 1.2−2.7) were associated with higher likelihood of peri-intubation cardiac arrest. The association between pre-intubation shock and cardiac arrest persisted in additional modeling stratified by ETI indication, induction agent, and oxygenation status.
Peri-intubation cardiac arrest for patients undergoing ETI in the ED is rare. Higher likelihood of arrest occurs in patients with pre-intubation shock or hypoxemia. Prospective trials are necessary to determine whether a protocol to optimize pre-intubation haemodynamics and oxygenation mitigates the risk of peri-intubation cardiac arrest.</description><identifier>ISSN: 0300-9572</identifier><identifier>EISSN: 1873-1570</identifier><identifier>DOI: 10.1016/j.resuscitation.2021.02.039</identifier><identifier>PMID: 33684505</identifier><language>eng</language><publisher>Ireland: Elsevier B.V</publisher><subject>Adolescent ; Adverse event ; Airway ; Cardiac arrest ; Emergency Service, Hospital ; Heart Arrest - epidemiology ; Heart Arrest - therapy ; Humans ; Hypotension ; Hypoxemia ; Intubation ; Intubation, Intratracheal - adverse effects ; Mortality ; Prospective Studies ; Registries</subject><ispartof>Resuscitation, 2021-05, Vol.162, p.403-411</ispartof><rights>2021</rights><rights>Published by Elsevier B.V.</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c383t-569c02fc79c21cf58def9538deac3e85107a074d1f3fcd7f7e9bde1af1f5652f3</citedby><cites>FETCH-LOGICAL-c383t-569c02fc79c21cf58def9538deac3e85107a074d1f3fcd7f7e9bde1af1f5652f3</cites><orcidid>0000-0002-5482-3569 ; 0000-0001-5621-441X ; 0000-0003-4770-8869 ; 0000-0002-1313-5241 ; 0000-0003-4141-0738</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktohtml>$$Uhttps://dx.doi.org/10.1016/j.resuscitation.2021.02.039$$EHTML$$P50$$Gelsevier$$H</linktohtml><link.rule.ids>314,780,784,3550,27924,27925,45995</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/33684505$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>April, Michael D.</creatorcontrib><creatorcontrib>Arana, Allyson</creatorcontrib><creatorcontrib>Reynolds, Joshua C.</creatorcontrib><creatorcontrib>Carlson, Jestin N.</creatorcontrib><creatorcontrib>Davis, William T.</creatorcontrib><creatorcontrib>Schauer, Steven G.</creatorcontrib><creatorcontrib>Oliver, Joshua J.</creatorcontrib><creatorcontrib>Summers, Shane M.</creatorcontrib><creatorcontrib>Long, Brit</creatorcontrib><creatorcontrib>Walls, Ron M.</creatorcontrib><creatorcontrib>Brown, Calvin A.</creatorcontrib><creatorcontrib>Brown, Calvin</creatorcontrib><creatorcontrib>April, Michael D.</creatorcontrib><creatorcontrib>Carlson, Jestin</creatorcontrib><creatorcontrib>Chan, Eugene</creatorcontrib><creatorcontrib>Driver, Brian</creatorcontrib><creatorcontrib>Fix, Megan</creatorcontrib><creatorcontrib>Gatewood, Medley</creatorcontrib><creatorcontrib>Hansen, Matthew</creatorcontrib><creatorcontrib>Hurley, Bruce</creatorcontrib><creatorcontrib>Kaji, Amy</creatorcontrib><creatorcontrib>Kilgo, Bob</creatorcontrib><creatorcontrib>Lauerman, Nicholas</creatorcontrib><creatorcontrib>Lutfy-Clayton, Lucienne</creatorcontrib><creatorcontrib>Miller, Stephen</creatorcontrib><creatorcontrib>Murray, Matthew</creatorcontrib><creatorcontrib>Nguyen, Margaret</creatorcontrib><creatorcontrib>Riordan, John</creatorcontrib><creatorcontrib>Runde, Daniel</creatorcontrib><creatorcontrib>Sandefur, Benjamin</creatorcontrib><creatorcontrib>Severyn, Fred</creatorcontrib><creatorcontrib>Shochat, Guy</creatorcontrib><creatorcontrib>Trent, Stacy</creatorcontrib><creatorcontrib>Wilcox, Susan</creatorcontrib><creatorcontrib>For the NEAR Investigators</creatorcontrib><creatorcontrib>NEAR Investigators</creatorcontrib><title>Peri-intubation cardiac arrest in the Emergency Department: A National Emergency Airway Registry (NEAR) study</title><title>Resuscitation</title><addtitle>Resuscitation</addtitle><description>To determine the incidence of peri-intubation cardiac arrest through analysis of a multi-center Emergency Department (ED) airway registry and to report associated clinical characteristics.
This is a secondary analysis of prospectively collected data (National Emergency Airway Registry) comprising ED endotracheal intubations (ETIs) of subjects >14 years old from 2016 to 2018. We excluded those with cardiac arrest prior to intubation. The primary outcome was peri-intubation cardiac arrest. Multivariable logistic regression generated adjusted odds ratios (aOR) of variables associated with this outcome, controlling for clinical features, difficult airway characteristics, and ETI modality.
Of 15,776 subjects who met selection criteria, 157 (1.0%, 95% CI 0.9–1.2%) experienced peri-intubation cardiac arrest. Pre-intubation systolic blood pressure <100 mm Hg (aOR 6.2, 95% CI 2.5–8.5), pre-intubation oxygen saturation <90% (aOR 3.1, 95% CI 2.0−4.8), and clinician-reported need for immediate intubation without time for full preparation (aOR 1.8, 95% CI, 1.2−2.7) were associated with higher likelihood of peri-intubation cardiac arrest. The association between pre-intubation shock and cardiac arrest persisted in additional modeling stratified by ETI indication, induction agent, and oxygenation status.
Peri-intubation cardiac arrest for patients undergoing ETI in the ED is rare. Higher likelihood of arrest occurs in patients with pre-intubation shock or hypoxemia. Prospective trials are necessary to determine whether a protocol to optimize pre-intubation haemodynamics and oxygenation mitigates the risk of peri-intubation cardiac arrest.</description><subject>Adolescent</subject><subject>Adverse event</subject><subject>Airway</subject><subject>Cardiac arrest</subject><subject>Emergency Service, Hospital</subject><subject>Heart Arrest - epidemiology</subject><subject>Heart Arrest - therapy</subject><subject>Humans</subject><subject>Hypotension</subject><subject>Hypoxemia</subject><subject>Intubation</subject><subject>Intubation, Intratracheal - adverse effects</subject><subject>Mortality</subject><subject>Prospective Studies</subject><subject>Registries</subject><issn>0300-9572</issn><issn>1873-1570</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2021</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNqNkE1vEzEURS0EomnhLyBLbMpihmc7jsewikr4kKqCKlhbjv1cHGVmgu0Bzb-v2xQEO1Zvc-69eoeQlwxaBmz1etcmzFN2sdgSx6HlwFkLvAWhH5EF65RomFTwmCxAADRaKn5CTnPeAYCQWj0lJ0KsuqUEuSD9F0yxiUOZtvdt1Nnko3XUprpSaBxo-Y5002O6wcHN9B0ebCo9DuUNXdOr-5Dd_wWsY_plZ3qNNzGXNNPzq836-hXNZfLzM_Ik2H3G5w_3jHx7v_l68bG5_Pzh08X6snGiE6WRK-2AB6e048wF2XkMWop6rBPYSQbKglp6FkRwXgWFeuuR2cCCXEkexBk5P_Ye0vhjqn-YPmaH-70dcJyy4UutheYcuoq-PaIujTknDOaQYm_TbBiYO99mZ_7xbe58G-Cm-q7pFw9D07ZH_yf7W3AFNkcA67s_IyZTi6on9DGhK8aP8b-GbgHRS5sk</recordid><startdate>202105</startdate><enddate>202105</enddate><creator>April, Michael D.</creator><creator>Arana, Allyson</creator><creator>Reynolds, Joshua C.</creator><creator>Carlson, Jestin N.</creator><creator>Davis, William T.</creator><creator>Schauer, Steven G.</creator><creator>Oliver, Joshua J.</creator><creator>Summers, Shane M.</creator><creator>Long, Brit</creator><creator>Walls, Ron M.</creator><creator>Brown, Calvin A.</creator><creator>Brown, Calvin</creator><creator>April, Michael D.</creator><creator>Carlson, Jestin</creator><creator>Chan, Eugene</creator><creator>Driver, Brian</creator><creator>Fix, Megan</creator><creator>Gatewood, Medley</creator><creator>Hansen, Matthew</creator><creator>Hurley, Bruce</creator><creator>Kaji, Amy</creator><creator>Kilgo, Bob</creator><creator>Lauerman, Nicholas</creator><creator>Lutfy-Clayton, Lucienne</creator><creator>Miller, Stephen</creator><creator>Murray, Matthew</creator><creator>Nguyen, Margaret</creator><creator>Riordan, John</creator><creator>Runde, Daniel</creator><creator>Sandefur, Benjamin</creator><creator>Severyn, Fred</creator><creator>Shochat, Guy</creator><creator>Trent, Stacy</creator><creator>Wilcox, Susan</creator><general>Elsevier B.V</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope><orcidid>https://orcid.org/0000-0002-5482-3569</orcidid><orcidid>https://orcid.org/0000-0001-5621-441X</orcidid><orcidid>https://orcid.org/0000-0003-4770-8869</orcidid><orcidid>https://orcid.org/0000-0002-1313-5241</orcidid><orcidid>https://orcid.org/0000-0003-4141-0738</orcidid></search><sort><creationdate>202105</creationdate><title>Peri-intubation cardiac arrest in the Emergency Department: A National Emergency Airway Registry (NEAR) study</title><author>April, Michael D. ; Arana, Allyson ; Reynolds, Joshua C. ; Carlson, Jestin N. ; Davis, William T. ; Schauer, Steven G. ; Oliver, Joshua J. ; Summers, Shane M. ; Long, Brit ; Walls, Ron M. ; Brown, Calvin A. ; Brown, Calvin ; April, Michael D. ; Carlson, Jestin ; Chan, Eugene ; Driver, Brian ; Fix, Megan ; Gatewood, Medley ; Hansen, Matthew ; Hurley, Bruce ; Kaji, Amy ; Kilgo, Bob ; Lauerman, Nicholas ; Lutfy-Clayton, Lucienne ; Miller, Stephen ; Murray, Matthew ; Nguyen, Margaret ; Riordan, John ; Runde, Daniel ; Sandefur, Benjamin ; Severyn, Fred ; Shochat, Guy ; Trent, Stacy ; Wilcox, Susan</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c383t-569c02fc79c21cf58def9538deac3e85107a074d1f3fcd7f7e9bde1af1f5652f3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2021</creationdate><topic>Adolescent</topic><topic>Adverse event</topic><topic>Airway</topic><topic>Cardiac arrest</topic><topic>Emergency Service, Hospital</topic><topic>Heart Arrest - epidemiology</topic><topic>Heart Arrest - therapy</topic><topic>Humans</topic><topic>Hypotension</topic><topic>Hypoxemia</topic><topic>Intubation</topic><topic>Intubation, Intratracheal - adverse effects</topic><topic>Mortality</topic><topic>Prospective Studies</topic><topic>Registries</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>April, Michael D.</creatorcontrib><creatorcontrib>Arana, Allyson</creatorcontrib><creatorcontrib>Reynolds, Joshua C.</creatorcontrib><creatorcontrib>Carlson, Jestin N.</creatorcontrib><creatorcontrib>Davis, William T.</creatorcontrib><creatorcontrib>Schauer, Steven G.</creatorcontrib><creatorcontrib>Oliver, Joshua J.</creatorcontrib><creatorcontrib>Summers, Shane M.</creatorcontrib><creatorcontrib>Long, Brit</creatorcontrib><creatorcontrib>Walls, Ron M.</creatorcontrib><creatorcontrib>Brown, Calvin A.</creatorcontrib><creatorcontrib>Brown, Calvin</creatorcontrib><creatorcontrib>April, Michael D.</creatorcontrib><creatorcontrib>Carlson, Jestin</creatorcontrib><creatorcontrib>Chan, Eugene</creatorcontrib><creatorcontrib>Driver, Brian</creatorcontrib><creatorcontrib>Fix, Megan</creatorcontrib><creatorcontrib>Gatewood, Medley</creatorcontrib><creatorcontrib>Hansen, Matthew</creatorcontrib><creatorcontrib>Hurley, Bruce</creatorcontrib><creatorcontrib>Kaji, Amy</creatorcontrib><creatorcontrib>Kilgo, Bob</creatorcontrib><creatorcontrib>Lauerman, Nicholas</creatorcontrib><creatorcontrib>Lutfy-Clayton, Lucienne</creatorcontrib><creatorcontrib>Miller, Stephen</creatorcontrib><creatorcontrib>Murray, Matthew</creatorcontrib><creatorcontrib>Nguyen, Margaret</creatorcontrib><creatorcontrib>Riordan, John</creatorcontrib><creatorcontrib>Runde, Daniel</creatorcontrib><creatorcontrib>Sandefur, Benjamin</creatorcontrib><creatorcontrib>Severyn, Fred</creatorcontrib><creatorcontrib>Shochat, Guy</creatorcontrib><creatorcontrib>Trent, Stacy</creatorcontrib><creatorcontrib>Wilcox, Susan</creatorcontrib><creatorcontrib>For the NEAR Investigators</creatorcontrib><creatorcontrib>NEAR Investigators</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>Resuscitation</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>April, Michael D.</au><au>Arana, Allyson</au><au>Reynolds, Joshua C.</au><au>Carlson, Jestin N.</au><au>Davis, William T.</au><au>Schauer, Steven G.</au><au>Oliver, Joshua J.</au><au>Summers, Shane M.</au><au>Long, Brit</au><au>Walls, Ron M.</au><au>Brown, Calvin A.</au><au>Brown, Calvin</au><au>April, Michael D.</au><au>Carlson, Jestin</au><au>Chan, Eugene</au><au>Driver, Brian</au><au>Fix, Megan</au><au>Gatewood, Medley</au><au>Hansen, Matthew</au><au>Hurley, Bruce</au><au>Kaji, Amy</au><au>Kilgo, Bob</au><au>Lauerman, Nicholas</au><au>Lutfy-Clayton, Lucienne</au><au>Miller, Stephen</au><au>Murray, Matthew</au><au>Nguyen, Margaret</au><au>Riordan, John</au><au>Runde, Daniel</au><au>Sandefur, Benjamin</au><au>Severyn, Fred</au><au>Shochat, Guy</au><au>Trent, Stacy</au><au>Wilcox, Susan</au><aucorp>For the NEAR Investigators</aucorp><aucorp>NEAR Investigators</aucorp><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Peri-intubation cardiac arrest in the Emergency Department: A National Emergency Airway Registry (NEAR) study</atitle><jtitle>Resuscitation</jtitle><addtitle>Resuscitation</addtitle><date>2021-05</date><risdate>2021</risdate><volume>162</volume><spage>403</spage><epage>411</epage><pages>403-411</pages><issn>0300-9572</issn><eissn>1873-1570</eissn><abstract>To determine the incidence of peri-intubation cardiac arrest through analysis of a multi-center Emergency Department (ED) airway registry and to report associated clinical characteristics.
This is a secondary analysis of prospectively collected data (National Emergency Airway Registry) comprising ED endotracheal intubations (ETIs) of subjects >14 years old from 2016 to 2018. We excluded those with cardiac arrest prior to intubation. The primary outcome was peri-intubation cardiac arrest. Multivariable logistic regression generated adjusted odds ratios (aOR) of variables associated with this outcome, controlling for clinical features, difficult airway characteristics, and ETI modality.
Of 15,776 subjects who met selection criteria, 157 (1.0%, 95% CI 0.9–1.2%) experienced peri-intubation cardiac arrest. Pre-intubation systolic blood pressure <100 mm Hg (aOR 6.2, 95% CI 2.5–8.5), pre-intubation oxygen saturation <90% (aOR 3.1, 95% CI 2.0−4.8), and clinician-reported need for immediate intubation without time for full preparation (aOR 1.8, 95% CI, 1.2−2.7) were associated with higher likelihood of peri-intubation cardiac arrest. The association between pre-intubation shock and cardiac arrest persisted in additional modeling stratified by ETI indication, induction agent, and oxygenation status.
Peri-intubation cardiac arrest for patients undergoing ETI in the ED is rare. Higher likelihood of arrest occurs in patients with pre-intubation shock or hypoxemia. Prospective trials are necessary to determine whether a protocol to optimize pre-intubation haemodynamics and oxygenation mitigates the risk of peri-intubation cardiac arrest.</abstract><cop>Ireland</cop><pub>Elsevier B.V</pub><pmid>33684505</pmid><doi>10.1016/j.resuscitation.2021.02.039</doi><tpages>9</tpages><orcidid>https://orcid.org/0000-0002-5482-3569</orcidid><orcidid>https://orcid.org/0000-0001-5621-441X</orcidid><orcidid>https://orcid.org/0000-0003-4770-8869</orcidid><orcidid>https://orcid.org/0000-0002-1313-5241</orcidid><orcidid>https://orcid.org/0000-0003-4141-0738</orcidid></addata></record> |
| fulltext | fulltext |
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| ispartof | Resuscitation, 2021-05, Vol.162, p.403-411 |
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| language | eng |
| recordid | cdi_proquest_miscellaneous_2499392208 |
| source | MEDLINE; Access via ScienceDirect (Elsevier) |
| subjects | Adolescent Adverse event Airway Cardiac arrest Emergency Service, Hospital Heart Arrest - epidemiology Heart Arrest - therapy Humans Hypotension Hypoxemia Intubation Intubation, Intratracheal - adverse effects Mortality Prospective Studies Registries |
| title | Peri-intubation cardiac arrest in the Emergency Department: A National Emergency Airway Registry (NEAR) study |
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