TY - JOUR
T1 - Risk Factors for Peri-Intubation Cardiac Arrest in Pediatric Cardiac Intensive Care Patients
T2 - A Multicenter Study∗
AU - Esangbedo, Ivie D.
AU - Byrnes, Jonathan
AU - Brandewie, Katie
AU - Ebraheem, Mohammad
AU - Yu, Priscilla
AU - Zhang, Song
AU - Raymond, Tia
N1 - Publisher Copyright:
© 2020 Lippincott Williams and Wilkins. All rights reserved.
PY - 2020/12/1
Y1 - 2020/12/1
N2 - Objectives: Endotracheal intubation is associated with hemodynamic adverse events, including cardiac arrest, especially in patients with cardiac disease. There are only a few studies that have evaluated the rate of and risk factors for endotracheal intubation hemodynamic complications in critically ill pediatric patients. Although some of these studies have assessed hemodynamic complications during intubation in pediatric cardiac patients, the frequency of and risk factors for peri-intubation cardiac arrest have not been adequately described in high acuity cardiac patients. This study aims to describe the frequency of and risk factors for peri-intubation cardiac arrest in critically ill pediatric cardiac patients admitted to specialized cardiac ICUs. Design: Multicenter retrospective cohort study. Setting: Three pediatric cardiac ICUs in the United States. Patients: Critically ill pediatric patients with congenital or acquired heart disease requiring endotracheal intubation. Interventions: None. Measurements and Main Results: Endotracheal intubations performed in three cardiac ICUs between January 2015 and December 2017 were reviewed. Clinical variables - including data on patients, clinical providers, and procedure - were evaluated for their association with peri-intubation cardiac arrest. There was a total of 186 intubation events studied, occurring in 151 individual (index) patients. The rates of peri-intubation cardiac arrest and peri-intubation mortality in this cohort were 7% and 1.6%, respectively. Among those patients with moderate or severe systolic dysfunction of the systemic ventricle, peri-intubation cardiac arrest rate was 20.7%. Statistically significant risk factors for peri-intubation cardiac arrest included: significant systolic dysfunction of the systemic ventricle, pre-intubation hypotension, pre-intubation lactate elevation, lower pre-intubation pH, and documented oxygen desaturations (> 10%) during intubation procedure. Conclusions: Our most significant finding was a peri-intubation cardiac arrest rate which was much higher than previously published rates for both cardiac and noncardiac children who underwent endotracheal intubation in ICUs. Peri-intubation mortality was also high in our cohort. Regarding risk factors for peri-intubation arrest, significant systolic dysfunction of the systemic ventricle was strongly associated with cardiac arrest in this cohort.
AB - Objectives: Endotracheal intubation is associated with hemodynamic adverse events, including cardiac arrest, especially in patients with cardiac disease. There are only a few studies that have evaluated the rate of and risk factors for endotracheal intubation hemodynamic complications in critically ill pediatric patients. Although some of these studies have assessed hemodynamic complications during intubation in pediatric cardiac patients, the frequency of and risk factors for peri-intubation cardiac arrest have not been adequately described in high acuity cardiac patients. This study aims to describe the frequency of and risk factors for peri-intubation cardiac arrest in critically ill pediatric cardiac patients admitted to specialized cardiac ICUs. Design: Multicenter retrospective cohort study. Setting: Three pediatric cardiac ICUs in the United States. Patients: Critically ill pediatric patients with congenital or acquired heart disease requiring endotracheal intubation. Interventions: None. Measurements and Main Results: Endotracheal intubations performed in three cardiac ICUs between January 2015 and December 2017 were reviewed. Clinical variables - including data on patients, clinical providers, and procedure - were evaluated for their association with peri-intubation cardiac arrest. There was a total of 186 intubation events studied, occurring in 151 individual (index) patients. The rates of peri-intubation cardiac arrest and peri-intubation mortality in this cohort were 7% and 1.6%, respectively. Among those patients with moderate or severe systolic dysfunction of the systemic ventricle, peri-intubation cardiac arrest rate was 20.7%. Statistically significant risk factors for peri-intubation cardiac arrest included: significant systolic dysfunction of the systemic ventricle, pre-intubation hypotension, pre-intubation lactate elevation, lower pre-intubation pH, and documented oxygen desaturations (> 10%) during intubation procedure. Conclusions: Our most significant finding was a peri-intubation cardiac arrest rate which was much higher than previously published rates for both cardiac and noncardiac children who underwent endotracheal intubation in ICUs. Peri-intubation mortality was also high in our cohort. Regarding risk factors for peri-intubation arrest, significant systolic dysfunction of the systemic ventricle was strongly associated with cardiac arrest in this cohort.
KW - cardiac arrest
KW - cardiopulmonary resuscitation
KW - endotracheal intubation
KW - pediatric
KW - peri-intubation cardiac arrest
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U2 - 10.1097/PCC.0000000000002472
DO - 10.1097/PCC.0000000000002472
M3 - Article
C2 - 32740187
AN - SCOPUS:85097377249
SN - 1529-7535
VL - 21
SP - E1126-E1133
JO - Pediatric Critical Care Medicine
JF - Pediatric Critical Care Medicine
IS - 12
ER -