Cardiac Arrest and Mortality Related to Intubation Procedure in Critically Ill Adult Patients: A Multicenter Cohort Study. Issue 4 (April 2018)

• Record Type: Journal Article
• Authors: De Jong, Audrey; Rolle, Amélie; Molinari, Nicolas; Paugam-Burtz, Catherine; Constantin, Jean-Michel; Lefrant, Jean-Yves; Asehnoune, Karim; Jung, Boris; Futier, Emmanuel; Chanques, Gérald; Azoulay, Elie; Jaber, Samir
• Is Part Of: Critical care medicine. Volume 46:Issue 4(2018)
• Publication Date: 2018-04
• Subjects: airway -- cardiac arrest -- critical care -- intubation -- mechanical ventilation; Critical care medicine -- Periodicals; Soins intensifs -- Périodiques; 616.028
• DOI: 10.1097/CCM.0000000000002925
• Languages: English
• ISSNs: 0090-3493

Abstract

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 2 ; 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. Abstract : Supplemental Digital Content is available in the text.