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What’s Leading to Peri-intubation Cardiac Arrest?

May 3, 2021

Written by Aaron Lacy

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Peri-intubation arrest is uncommon, but the likelihood increases with pre-intubation hypotension, hypoxemia, or a rushed preparation.

Why does this matter?
Patients who require intubation are often in critical condition. While peri-intubation arrest is rare, recognition of factors that may take a patient’s day from bad to worse are important.

Secure that airway – carefully
We have covered the physiologically risky airway before, and this secondary analysis of NEAR data helps solidify what we already know to prevent death by intubation. In 15,776 intubations only 1% (157, 95% CI 0.9-1.2%) suffered peri-intubation cardiac arrest. Systolic blood pressure <100 (aOR 6.2, 95% CI 2.5-8.5), pre-intubation oxygen saturation <90% (aOR 3.1, 95% CI 2.0-4.8), and clinician reported need for immediate intubation without time for full preparation (aOR 1.8, 95% CI 1.2-2.7) were all associated with higher likelihood of this devastating complication.

In studies looking at peri-intubation cardiac arrest, the same factors come up repeatedly with variables we can control. When possible, aggressively resuscitate your patient before intubation to improve their hemodynamics. Practice good preoxygenation, and apneic oxygenation maybe helps (but doesn’t hurt). No matter how urgent an airway seems, we know that implementation of a pre-intubation checklist prevents adverse events. As our specialty has progressed so has our understanding of securing the ABCs – secure carefully.

Peri-intubation cardiac arrest in the Emergency Department: A National Emergency Airway Registry (NEAR) study. Resuscitation. 2021 Mar 5;S0300-9572(21)00097-6. doi: 10.1016/j.resuscitation.2021.02.039. Online ahead of print.

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