Peri-Intubation Cardiac Arrest

• Endotracheal intubation is a high-risk procedure, especially in the critically ill patient.
• The incidence of peri-intubation cardiac arrest ranges from 2% to 5%, and is associated with significant increases in morbidity and mortality.
• Authors of a recent retrospective analysis across 64 French ICUs sought to determine risk factors for cardiac arrest during ICU intubation.
• Among 1,847 intubations, the main predictors of cardiac arrest during intubation were:
  • Pre-intubation arterial hypotension (SBP < 90 mm Hg) (OR 3.4)
  • Pre-intubation hypoxemia (OR 3.99)
  • Absence of preoxygenation (OR 3.58)
  • Obesity (OR 2)
  • Age > 75 years of age (OR 2.25)
• Take Home Point
  • Pay close attention to these risk factors and "resuscitate before you intubate".

References

De Jong A, et al. Cardiac arrest and mortality related to intubation procedure in critically ill adult patients: A multicenter cohort study. Crit Care Med. 2018; 46:532-9.