Document Type
Article
Publication Date
8-30-2024
Abstract
BACKGROUND: Tracheal 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.
METHODS: Secondary 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).
RESULTS: Among 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.
CONCLUSIONS: Fifteen 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 REGISTRATION: The ICU-RESUS (ClinicalTrials.gov Identifier: NCT02837497).
Recommended Citation
Nishisaki, Akira; Reeder, Ron; Laverriere McGovern, Elizabeth; Ahmed, Tageldin; Bell, Michael; Bishop, Robert; Bochkoris, Matthew; Burns, Candice; Carcillo, Joseph; Carpenter, Todd; Diddle, Wesley; Federman, Myke; Fink, Ericka; Franzon, Deborah; Frazier, Aisha; Friess, Stuart; Graham, Kathryn; Hall, Mark; Hehir, David; Horvat, Christopher M; Huard, Leanna; Maa, Tensing; Manga, Arushi; McQuillen, Patrick; Meert, Kathleen; Morgan, Ryan; Mourani, Peter; Nadkarni, Vinay; Naim, Maryam; Notterman, Daniel; Palmer, Chella; Sapru, Anil; Schneiter, Carleen; Sharron, Matthew; Srivastava, Neeraj; Viteri, Shirley; Wessel, David; Wolfe, Heather; Yates, Andrew; Zuppa, Athena; Sutton, Robert; and Berg, Robert, "Brief Report: Incidence and Outcomes of Pediatric Tracheal Intubation-Associated Cardiac Arrests in the ICU-RESUS Clinical Trial" (2024). Department of Pediatrics Faculty Papers. Paper 161.
https://jdc.jefferson.edu/pedsfp/161
Creative Commons License
This work is licensed under a Creative Commons Attribution-Noncommercial-No Derivative Works 4.0 License.
PubMed ID
39215367
Language
English
Comments
This article is the author's final published version in Critical Care, Volume 28, Issue 1, 2024, Article number 286.
The published version is available at https://doi.org/10.1186/s13054-024-05065-0.
Copyright © The Author(s) 2024