Emergent endotracheal intubation associated cardiac arrest, risks, and emergency implications
Emergent endotracheal intubation (ETI)-related cardiac arrest (CA) is a life-threatening complication that is poorly documented. Definitions and risk factors for CA during or directly after emergent ETI have not been clearly established and may represent modifiable means of improving patient outcomes. We conducted a review of the literature to assess the incidence and risk factors associated with ETI-related CA in the Emergency Department (ED) as well as in the inpatient setting outside of the operating room. Retrospective studies demonstrated that ETI-related CA incidence was between 1.7% and 23% in both the ED and the inpatient setting. Pre-intubation hypoxemia, hypotension, Shock Index (SI), Body Mass Index, and age were most associated with CA. Medications used for induction and number of attempts were identified as risk factors. Definitions of ETI-related CA also varied considerably ranging from within 5 min to within 60 min of intubation; however, the majority of ETI-related CA cases occurred within 10 min. Hemodynamic factors such as SI, hypotension, and hypoxemia were associated with increased rates of CA. ETI-related CA may represent a potentially modifiable complication that can improve patient outcomes in critically ill patients presenting in the ED.
KeywordsEmergent Endotracheal intubation Cardiac arrest Risk factors
This study was not funded.
Compliance with ethical standards
Conflict of interest
No competing financial interests exist.
- 4.De Jong A, Rolle A, Molinari N, Paugam-Burtz C, Constantin JM, Lefrant JY, Asehnoune K, Jung B, Futier E, Chanques G, Azoulay E, Jaber S. Cardiac arrest and mortality related to intubation procedure in critically Ill adult patients: a multicenter cohort study. Crit Care Med. 2018;46(4):532–9.CrossRefPubMedGoogle Scholar
- 19.Heffner AC, Swords D, Kline JA, Jones AE. The frequency and significance of postintubation hypotension during emergency airway management. J Crit Care. 2012;417:419–413.Google Scholar
- 25.Jaber S, Jung B, Corne P, Sebbane M, Muller L, Chanques G, Verzilli D, Jonquet O, Eledjam JJ, Lefrant JY. An intervention to decrease complications related to endotracheal intubation in the intensive care unit: a prospective, multiple-center study. Intensive Care Med. 2010;36(2):248–55.CrossRefPubMedGoogle Scholar
- 27.Uribe AA, Zvara DA, Puente EG, Otey AJ, Zhang J, Bergese SD. BMI as a predictor for potential difficult tracheal intubation in males. Front Med 2015;2(38).Google Scholar
- 28.Apfelbaum JL, Hagberg CA, Caplan RA, Blitt CD, Connis RT, Nickinovich DG, Hagberg CA, Caplan RA, Benumof JL, Berry FA, Blitt CD, Bode RH, Cheney FW, Connis RT, Guidry OF, Nickinovich DG, Ovassapian A. Practice guidelines for management of the difficult airway: an updated report by the American Society of Anesthesiologists Task Force on management of the difficult airway. Anesthesiology. 2013;118(2):251–70.CrossRefPubMedGoogle Scholar