Factors associated with the occurrence of cardiac arrest after emergency tracheal intubation in the emergency department.
OBJECTIVE
Emergency tracheal intubation has achieved high success and low complication rates in the emergency department (ED). The objective of this study was to evaluate the incidence of post-intubation CA and determine the clinical factors associated with this complication.


METHODS
A matched case-control study with a case to control ratio of 1:3 was conducted at an urban tertiary care center between January 2007 and December 2011. Critically ill adult patients requiring emergency airway management in the ED were included. The primary endpoint was post-intubation CA, defined as CA within 10 minutes after tracheal intubation. Clinical variables were compared between patients with post-intubation CA and patients without CA who were individually matched based on age, sex, and pre-existing comorbidities.


RESULTS
Of 2,403 patients who underwent emergency tracheal intubation, 41 patients (1.7%) had a post-intubation CA within 10 minutes of the procedure. The most common initial rhythm was pulseless electrical activity (78.1%). Patients experiencing CA had higher in-hospital mortality than patients without CA (61.0% vs. 30.1%; p<0.001). Systolic hypotension prior to intubation, defined as a systolic blood pressure ≤ 90 mmHg, was independently associated with post-intubation CA (OR, 3.67 [95% CI, 1.58-8.55], p = 0.01).


CONCLUSIONS
Early post-intubation CA occurred with an approximate 2% frequency in the ED. Systolic hypotension before intubation is associated with this complication, which has potentially significant implications for clinicians at the time of intubation.
Department of Emergency Medicine, Ulsan University College of Medicine, Asan Medical Center, Seoul, Korea; Department of Emergency Medicine, Seoul Medical Center, Seoul, Korea.
Won Young
WY
Kim
Department of Emergency Medicine, Seoul Medical Center, Seoul, Korea.
Myoung Kwan
MK
Kwak
Department of Emergency Medicine, Ulsan University College of Medicine, Asan Medical Center, Seoul, Korea.
Byuk Sung
BS
Ko
Department of Emergency Medicine, Chonbuk National University Hospital, Jeonju, Korea.
Jae Chol
JC
Yoon
Department of Emergency Medicine, Ulsan University College of Medicine, Asan Medical Center, Seoul, Korea.
Chang Hwan
CH
Sohn
Department of Emergency Medicine, Ulsan University College of Medicine, Asan Medical Center, Seoul, Korea.
Kyoung Soo
KS
Lim
Department of Emergency Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts, United States of America; Department of Anesthesiology, Aarhus University Hospital, Aarhus, Denmark.
Lars W
LW
Andersen
Department of Emergency Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts, United States of America.
Michael W
MW
Donnino
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D016022:Case-Control Studies; D004630:Emergencies; D004636:Emergency Service, Hospital; D005260:Female; D006323:Heart Arrest / Q000453:epidemiology* / Q000209:etiology*; D006801:Humans; D015994:Incidence; D007442:Intubation, Intratracheal / Q000009:adverse effects*; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012307:Risk Factors