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PLoS One. 2014 Nov 17;9(11):e112779. doi: 10.1371/journal.pone.0112779. eCollection 2014.

Factors associated with the occurrence of cardiac arrest after emergency tracheal intubation in the emergency department.

Author information

1
Department of Emergency Medicine, Ulsan University College of Medicine, Asan Medical Center, Seoul, Korea; Department of Emergency Medicine, Seoul Medical Center, Seoul, Korea.
2
Department of Emergency Medicine, Seoul Medical Center, Seoul, Korea.
3
Department of Emergency Medicine, Ulsan University College of Medicine, Asan Medical Center, Seoul, Korea.
4
Department of Emergency Medicine, Chonbuk National University Hospital, Jeonju, Korea.
5
Department of Emergency Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts, United States of America; Department of Anesthesiology, Aarhus University Hospital, Aarhus, Denmark.
6
Department of Emergency Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts, United States of America.

Abstract

OBJECTIVES:

Emergency tracheal intubation has achieved high success and low complication rates in the emergency department (ED). The objective of this study was to evaluate the incidence of post-intubation CA and determine the clinical factors associated with this complication.

METHODS:

A matched case-control study with a case to control ratio of 1:3 was conducted at an urban tertiary care center between January 2007 and December 2011. Critically ill adult patients requiring emergency airway management in the ED were included. The primary endpoint was post-intubation CA, defined as CA within 10 minutes after tracheal intubation. Clinical variables were compared between patients with post-intubation CA and patients without CA who were individually matched based on age, sex, and pre-existing comorbidities.

RESULTS:

Of 2,403 patients who underwent emergency tracheal intubation, 41 patients (1.7%) had a post-intubation CA within 10 minutes of the procedure. The most common initial rhythm was pulseless electrical activity (78.1%). Patients experiencing CA had higher in-hospital mortality than patients without CA (61.0% vs. 30.1%; p<0.001). Systolic hypotension prior to intubation, defined as a systolic blood pressure ≤ 90 mmHg, was independently associated with post-intubation CA (OR, 3.67 [95% CI, 1.58-8.55], p = 0.01).

CONCLUSION:

Early post-intubation CA occurred with an approximate 2% frequency in the ED. Systolic hypotension before intubation is associated with this complication, which has potentially significant implications for clinicians at the time of intubation.

PMID:
25402500
PMCID:
PMC4234501
DOI:
10.1371/journal.pone.0112779
[Indexed for MEDLINE]
Free PMC Article

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