Demographic disparities in tracheal intubation success rates during infant out-of-hospital cardiac arrest. (February 2023)

• Record Type: Journal Article
• Authors: Shekhar, Aditya C.; Coute, Ryan A.; Mader, Timothy J.; Del Rios, Marina; Peeler, Katherine R.; Mann, N Clay; Madhok, Manu
• Is Part Of: Trends in anaesthesia and critical care. Volume 48(2023)
• Publication Date: 2023-02
• Subjects: Cardiac arrest -- Health disparities -- Intubation -- Infant cardiac arrest -- Airway management; Anesthesia -- Periodicals; Critical care medicine -- Periodicals; Anesthesia in traumatology -- Periodicals; Anesthesia -- Case studies -- Periodicals; 617.9605
• DOI: 10.1016/j.tacc.2022.101210
• Languages: English
• ISSNs: 2210-8440

Abstract

Abstract: Objectives: Tracheal intubation is a skill performed by qualified emergency medical services (EMS) providers during out-of-hospital cardiac arrest (OHCA) in adult and pediatric patients. Unsuccessful intubation can negatively impact a patient's likelihood of survival. Thus, intubation success rates are an important quality improvement benchmark. Given other demographic disparities that have been reported in adults and children, we hypothesize there might be disparities in intubation success across infant race/ethnicity and/or sex. Methods: We examined a national-level registry of EMS activations in the United States (NEMSIS). Inclusion criteria were OHCA calls involving infant patients (under 1 years of age) between January 2017 and May 2022 where EMS attempted tracheal intubation, documented whether the procedure was successful, and documented information about the patient's demographics (eg. race/ethnicity and sex). Intubation success rates across patient sex and racial/ethnic categories with more than one-hundred cardiac arrests with intubation attempts were compared. Results: A total of 3663 infant cardiac arrests where tracheal intubation was attempted met inclusion criteria. White infants were associated with significantly higher rates of intubation success (62.2%) when compared with Black or African American infants (58.1%) and Hispanic/Latino infants (56.2%) (p < .01). Female infants were associated with slightly higher rates of intubation success than male infants, but this difference was not significant (p > .2). Conclusion: Significant demographic disparities in endotracheal intubation success rates exist among infants who experience OHCA. Future studies should continue to examine these disparities with the goal of identifying why these differences occur and concrete mechanisms for eliminating such disparities. Highlights: Evidence suggests racial/ethnic disparities in intubation success rates among adult out-of-hospital cardiac arrest patients. There is interest in identifying whether similar trends are seen in infants experiencing out-of-hospital cardiac arrest. National-level analysis of US EMS calls showed White infants had higher rates of intubation success than non-White infants. No significant difference in intubation success rates was seen when comparing male infants with female infants.