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Crit Care Med. 2018 Apr;46(4):532-539. doi: 10.1097/CCM.0000000000002925.

Cardiac Arrest and Mortality Related to Intubation Procedure in Critically Ill Adult Patients: A Multicenter Cohort Study.

Author information

1
Anesthesiology and Intensive Care, Anesthesia and Critical Care Department B, Saint Eloi Teaching Hospital, Unité INSERM U1046, Université Montpellier 1, Université Montpellier 2, Centre Hospitalier Universitaire Montpellier, Montpellier, France.
2
INSERM U1046, CNRS UMR 9214, Montpellier, France.
3
Department of Intensive Care & Anesthesiology, University of Pointe à Pitre Hospital. Guadeloupe, France.
4
Department of Statistics, University of Montpellier Lapeyronie Hospital, UMR 5149 IMAG, Montpellier, France.
5
Department of Intensive Care & Anesthesiology, University of Paris Diderot, Sorbonne Paris Cité, Paris, France.
6
AP-HP, Hôpital Beaujon, Paris, France.
7
Department of Intensive Care & Anesthesiology, Hotel-Dieu Hospital, University Hospital of Clermont Ferrand, Clermont-Ferrand, France.
8
Department of Intensive Care & Anesthesiology, University of Montpellier, Nimes Hospital, Nimes, France.
9
Department of Intensive Care & Anesthesiology, University of Nantes, Hotel-Dieu Hospital, Nantes, France.
10
Medical Intensive Care Unit, Lapeyronie Teaching Hospital, Centre Hospitalier Universitaire Montpellier, Montpellier, France.
11
Medical Intensive Care Unit, University of Paris-Diderot, Saint Louis Hospital, Paris, France.

Abstract

OBJECTIVES:

To determine the prevalence of and risk factors for cardiac arrest during intubation in ICU, as well as the association of ICU intubation-related cardiac arrest with 28-day mortality.

DESIGN:

Retrospective analysis of prospectively collected data.

SETTING:

Sixty-four French ICUs.

PATIENTS:

Critically ill patients requiring intubation in the ICU.

INTERVENTIONS:

None.

MEASUREMENTS AND MAIN RESULTS:

During the 1,847 intubation procedures included, 49 cardiac arrests (2.7%) occurred, including 14 without return of spontaneous circulation (28.6%) and 35 with return of spontaneous circulation (71.4%). In multivariate analysis, the main predictors of intubation-related cardiac arrest were arterial hypotension (systolic blood pressure < 90 mm Hg) prior to intubation (odds ratio = 3.406 [1.797-6.454]; p = 0.0002), hypoxemia prior to intubation (odds ratio = 3.991 [2.101-7.583]; p < 0.0001), absence of preoxygenation (odds ratio = 3.584 [1.287-9.985]; p = 0.0146), overweight/obesity (body mass index > 25 kg/m; odds ratio = 2.005 [1.017-3.951]; p = 0.0445), and age more than 75 years old (odds ratio = 2.251 [1.080-4.678]; p = 0.0297). Overall 28-day mortality rate was 31.2% (577/1,847) and was significantly higher in patients who experienced intubation-related cardiac arrest than in noncardiac arrest patients (73.5% vs 30.1%; p < 0.001). After multivariate analysis, intubation-related cardiac arrest was an independent risk factor for 28-day mortality (hazard ratio = 3.9 [2.4-6.3]; p < 0.0001).

CONCLUSIONS:

ICU intubation-related cardiac arrest occurs in one of 40 procedures with high immediate and 28-day mortality. We identified five independent risk factors for cardiac arrest, three of which are modifiable, possibly to decrease intubation-related cardiac arrest prevalence and 28-day ICU mortality.

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