Journal Article

Brief report: incidence and outcomes of pediatric tracheal intubation-associated cardiac arrests in the ICU-RESUS clinical trial

Nadkarni, Vinay M., Friess, Stuart H., Franzon, Deborah, Mourani, Peter M., Srivastava, Neeraj, Hall, Mark, Sapru, Anil, Huard, Leanna L., Reeder, Ron W., Sharron, Matthew P., Bochkoris, Matthew, Hehir, David A., Yates, Andrew R., Berg, Robert A., Bell, Michael J., Graham, Kathryn, Sutton, Robert M., Notterman, Daniel, Diddle, Wesley, Meert, Kathleen L., Palmer, Chella A., Manga, Arushi, Burns, Candice, Wessel, David, McGovern, Elizabeth Laverriere, Carcillo, Joseph A., McQuillen, Patrick, Carpenter, Todd C., Schneiter, Carleen, Federman, Myke, Wolfe, Heather A., Bishop, Robert, Viteri, Shirley, Maa, Tensing, Zuppa, Athena F., Naim, Maryam Y., Horvat, Christopher M., Frazier, Aisha H., Ahmed, Tageldin, Morgan, Ryan W., Nishisaki, Akira, Fink, Ericka L.

2024

Overview

Background Tracheal intubation (TI)-associated cardiac arrest (TI-CA) occurs in 1.7% of pediatric ICU TIs. Our objective was to evaluate resuscitation characteristics and outcomes between cardiac arrest patients with and without TI-CA. Methods Secondary analysis of cardiac arrest patients in both ICU-RESUS trial and ancillary CPR-NOVA study. The primary exposure was TI-CA, defined as cardiac arrest occurred during TI procedure or within 20 min after endotracheal tube placement. The primary outcome was survival to hospital discharge with favorable neurological outcome (Pediatric Cerebral Performance Category score 1–3 or unchanged). Results Among 315 children with cardiac arrests, 48 (15.2%) met criteria for TI-CA. Pre-existing medical conditions were similar between groups. Pre-arrest non-invasive mechanical ventilation was more common among TI-CA patients (18/48, 37.5%) compared to non-TI-CA patients (35/267, 13.1%). In 48% (23/48), the TI-CA occurred within 20 min after intubation (i.e., not during intubation). Duration of CPR was longer in TI-CA patients (median 11.0 min, interquartile range [IQR]: 2.5, 35.5) than non-TI-CA patients (median 5.0 min, IQR 2.0, 21.0), p  = 0.03. Return of spontaneous circulation occurred in 32/48 (66.7%) TI-CA versus 186/267 (69.7%) non-TI-CA, p  = 0.73. Survival to hospital discharge with favorable neurological outcome occurred in 29/48 (60.4%) TI-CA versus 146/267 (54.7%) non-TI-CA, p  = 0.53. Conclusions Fifteen percent of these pediatric ICU cardiac arrests were associated with TI. Half of TI-CA occurred after endotracheal tube placement. While duration of CPR was longer in TI-CA patients, there were no differences in unadjusted outcomes following TI-CA versus non-TI-CA. Trial Registration The ICU-RESUS (ClinicalTrials.gov Identifier: NCT 02837497).

• Publisher: BioMed Central,BioMed Central Ltd,Springer Nature B.V
• Subject: Adolescent / Airway management / Cardiac arrest / Cardiac patients / Cardiopulmonary resuscitation / Cardiopulmonary Resuscitation - adverse effects / Cardiopulmonary Resuscitation - methods / Cardiopulmonary Resuscitation - statistics & numerical data / Child / Child, Preschool / Children / Clinical trials / CPR / Critical Care Medicine / Data collection / Emergency medical care / Emergency Medicine / Female / Health aspects / Heart Arrest - epidemiology / Heart Arrest - mortality / Heart Arrest - therapy / Hemodynamics / Humans / Hypotension / Incidence / Infant / Intensive / Intensive Care Units, Pediatric - organization & administration / Intensive Care Units, Pediatric - statistics & numerical data / Intubation / Intubation, Intratracheal - adverse effects / Intubation, Intratracheal - methods / Intubation, Intratracheal - statistics & numerical data / Lifesaving / Male / Medicine / Medicine & Public Health / Patient outcomes / Pediatric cardiology / Pediatrics / Ventilators