Association of presence and timing of invasive airway placement with outcomes after pediatric in-hospital cardiac arrest.
BACKGROUND
Little data exist regarding the association of presence of an invasive airway before cardiac arrest or early placement of an invasive airway after cardiac arrest with outcomes in children who experience in-hospital cardiac arrest.


METHODS
We conducted a retrospective review of patients aged 1 day to 18 years who received cardiopulmonary resuscitation (CPR) for ≥ 1 min in any of the three intensive care units (ICUs) at a tertiary care, academic children's hospital between 2002 and 2010. Specific outcomes evaluated included survival to hospital discharge, return of spontaneous circulation (ROSC), 24-h survival, and good neurological status at hospital discharge. We fitted multivariable logistic regression models to evaluate the association between the presence of an invasive airway prior to cardiac arrest and timing of placement of an invasive airway with these outcomes.


RESULTS
Three hundred and ninety-one patients were included. Of these, 197 (51%) patients were already tracheally intubated before the occurrence of cardiac arrest. Median time to intubation was 6 min [interquartile range (IQR): 2, 12] among the 194 patients tracheally intubated following cardiac arrest. We found lower survival to hospital discharge among patients intubated prior to cardiac arrest (intubated vs. non-intubated group, 43% vs. 61%, p < 0.001). After adjusting for patient and event characteristics, presence of an invasive airway prior to cardiac arrest was not associated with a significant improvement in survival to hospital discharge [odds ratio (OR): 0.70, 95% confidence interval (CI): 0.42-1.16, p = 0.17], or good neurological outcomes (OR: 0.60, 95% CI: 0.34-1.05, p = 0.07). Similarly, early placement of an invasive airway after cardiac arrest was also not associated with an improvement in survival to hospital discharge (OR: 1.05, 95% CI: 0.78-1.42, p = 0.73), or good neurological outcomes (OR: 1.08, 95% CI: 0.77-1.53, p = 0.65).


CONCLUSIONS
Our study demonstrates that presence of an invasive airway prior to cardiac arrest or early placement of an invasive airway after cardiac arrest is not associated with an improvement in survival to hospital discharge or good neurological outcomes. Further study of the relationship between invasive airway management and survival following cardiac arrest is warranted.
Division of Pediatric Cardiology, University of Arkansas for Medical Sciences, Little Rock, AR, United States. Electronic address: pgupta2@uams.edu.
Punkaj
P
Gupta
Biostatistics Section, Department of Pediatrics, University of Arkansas for Medical Sciences, Little Rock, AR, United States.
Mallikarjuna
M
Rettiganti
Biostatistics Section, Department of Pediatrics, University of Arkansas for Medical Sciences, Little Rock, AR, United States.
Jeffrey M
JM
Gossett
Department of Medical Education, Stanford University School of Medicine, Palo Alto, CA, United States.
Karen
K
Kuo
Department of Medical Education, Stanford University School of Medicine, Palo Alto, CA, United States.
Vinca
V
Chow
Department of Medical Education, Stanford University School of Medicine, Palo Alto, CA, United States.
Duy T
DT
Dao
Division of Pediatric Cardiology, Department of Pediatrics, Stanford University Medical Center, Palo Alto, CA, United States.
Stephen J
SJ
Roth
D000293:Adolescent; D058109:Airway Management / Q000379:methods*; D016887:Cardiopulmonary Resuscitation / Q000379:methods*; D002648:Child; D002675:Child, Preschool; D005260:Female; D006323:Heart Arrest / Q000401:mortality / Q000628:therapy*; D006776:Hospitals, Pediatric; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D012189:Retrospective Studies; D015996:Survival Rate / Q000639:trends; D013997:Time Factors; D014481:United States / Q000453:epidemiology
Cardiac arrest; Children; Intubation; Invasive airway; Survival to hospital discharge