Risk factors associated with inpatient cardiac arrest during emergency endotracheal intubation at general wards

Abstract

Background: Peri-intubation cardiac arrest (PICA) is a rare but life-threatening complication. Emergency endotracheal intubation (ETI) can be more complicated at the general ward than in other spaces. Few studies have described PICA at the general ward. This study aimed to identify risk factors associated with PICA at general ward patients. Methods: We conducted a retrospective observational study of patients at two institutions between January 2016 to December 2017. Inclusion criteria were defined that general ward patients emergently intubated who experienced cardiac arrest within 20 minutes after ETI. The non-PICA group consisted of general ward patients emergently intubated without cardiac arrest. Results: Fifteen out of 362 patients (3.6%) presented a PICA that occurred during the study period. All PICA patients had unplanned intensive care unit (ICU) admissions and five of them are dead. Intubation-related shock index, several intubation attempts, pre-ETI vasopressor use, and neuromuscular blocking agent (NMBA) use, especially succinylcholine, were associated with PICA in our study. Clinical outcomes of ICU and hospital length of stay, survival to discharge, and neurologic outcome at hospital discharge were not significantly different between PICA and other types of inpatient cardiac arrest (OTICA). Conclusion: We identified four independent risk factors for PICA, and pre-intubation hemodynamic stabilization and avoidance of NMBA were possibly modifiable factors of PICA at the general ward. Clinical outcomes of PICA were similar to those of OTICA.