Factors and outcomes associated with inpatient cardiac arrest following emergent endotracheal intubation

Abstract

Background Inpatient peri-intubation cardiac arrest (PICA) following emergent endotracheal intubation (ETI) is an uncommon but potentially preventable type of cardiac arrest (CA). Limited published data exist describing factors associated with inpatient PICA and patient outcomes. This study identifies risk factors associated with PICA among hospitalized patients emergently intubated out of the operating room and compares PICA to other types of inpatient CA. Methods Retrospective case-control study of patients at our institution over a five-year period. Cases were defined as inpatients emergently intubated outside of the operating room that experienced cardiac arrest within 20 minutes after ETI. The control group consisted of inpatients emergently intubated out of the operating room without CA. Predictors of PICA were identified through univariate and multivariate analysis. Clinical outcomes were compared between PICA and other inpatient CAs, identified through a prospectively enrolled CA registry at our institution. Results 29 episodes of PICA occurred over 5 years, accounting for 5% of all inpatient arrests. Shock index ≥ 1.0, intubation within one hour of nursing shift change, and use of succinylcholine were independently associated with PICA. Sustained ROSC, survival to discharge, and neurocognitive outcome did not differ significantly between groups. Conclusion Patients outcomes following PICA were comparable to other causes of inpatient CA. Potentially modifiable factors were associated with PICA. Hemodynamic resuscitation, optimized staffing strategies, and possible avoidance of succinylcholine were associated with decreased risk of PICA. Clinical trials testing targeted strategies to optimize peri-intubation care are needed to identify effective interventions to prevent this potentially avoidable type of CA.

Corrigendum to: Risk factors associated with inpatient cardiac arrest during emergency endotracheal intubation at general wards

“…In the article titled “Risk factors associated with inpatient cardiac arrest during emergency endotracheal intubation at general wards” published on August 2019 [ 1 ], there was plagiarism suspicion as the abstract, limitation, and results are quite similar with those in the article by Wardi et al [ 2 ]. In response, the author explained that there are limitations in clinical research, such as the fact that many similar papers exist and that this study was not entirely new ideas, and that the target groups were set differently with retrospective study nature [ 2 - 5 ]. The author admitted to omitting to cite this paper [ 2 ] as a reference in the course of writing the paper.…”

“…In light of this view, pre-intubation hemodynamic instability, once confirmed, may reduce cardiac output during intubation and attenuate respiratory compensation in proportion to intubation time, leading to the deterioration of acidosis. Hemodynamic instability is also the main reason why the inhibition of neuromuscular blocking agents upon catecholamine secretion potentially causes cardiac arrest [17][18][19][20][21][22][23].…”

“…The intubation-related shock index, identified as one of risk factors of PICA in this study, was used as a measure of hemodynamic instability and intubation duration. Several studies have reported shock index as an independent predictor of PICA in Emergency Department patients and to emphasize the importance of intervention necessary to prevent cardiac arrest [18,24]. Further studies have been conducted to explore the index in ICU settings and to develop interventions effective in preventing complications related to ETI.…”

“…As a result, a study reported significantly decreased intubation-related complications, including PICA, after implementing intervention measures in which a checklist was prepared to keep track of all intravenous fluids or conscious intubation [25]. In the event of cardiac arrest in an Emergency Department or ICU, it is possible to take immediate actions, whereas rapid response to cardiac arrest on general wards becomes difficult due to the lack of monitoring facilities and attending medical personnel, understaffing, or restrictions on medication for intervention [18,26]. Therefore, the results of this study are expected to be clinically useful to improve procedures for PICA prevention within general wards when emergency intubation is necessary.…”

“…In response, the author explained that there are limitations in clinical research, such as the fact that many similar papers exist and that this study was not entirely new ideas, and that the target groups were set differently with retrospective study nature [ 2 - 5 ]. The author admitted to omitting to cite this paper [ 2 ] as a reference in the course of writing the paper. The Editorial Board of Acute and Critical Care decided to publish a corrigendum to correct this plagiarism controversy according to the flowchart of COPE.…”