Ko Byuk Sung, Ahn Ryeok, Ryoo Seung Mok, Ahn Shin, Sohn Chang Hwan, Seo Dong Woo, Lim Kyoung Soo, Kim Won Young
Department of Emergency Medicine, Ulsan University College of Medicine, Asan Medical Center, Seoul, Republic of Korea.
Department of Emergency Medicine, University of Ulsan College of Medicine, Ulsan University Hospital, Ulsan, Republic of Korea.
Am J Emerg Med. 2015 Nov;33(11):1642-5. doi: 10.1016/j.ajem.2015.07.083. Epub 2015 Aug 5.
Emergency endotracheal intubation-related cardiac arrest (CA) is not well documented. This study compares the clinical features and outcomes of intubation-related CA and other causes of inhospital CA.
All study patients were consecutive adults (≥18 years) who developed CA in the emergency department between January 2007 and December 2011. Emergent endotracheal intubation-related CA was defined as occurring within 20 minutes after successful intubation. Clinical variables were compared between patients with intubation-related CA and intubation-unrelated CA. The primary outcome was a good neurologic outcome defined as a Cerebral Performance Category score of 1 to 2. The secondary outcome was survival to hospital discharge.
Of the 251 patients who developed CA, 41 were excluded due to trauma-related CA or "do-not-resuscitate" protocols, thereby leaving 210 patients. The prevalence of intubation-related CA was 23.3%, and the median duration between successful intubation and CA was 5.0 minutes (interquartile range, 2.0-9.5). Pulseless electrical activity was more commonly noted as the first arrest rhythm in the intubation-related CA group (75.5% vs 59.0%; P = .03) compared with patients with other causes of CA. However, the rates of good neurologic outcomes (14.3% vs 21.1%) and survival to discharge (34.7% vs 35.4%) were not significantly higher in intubation-related CA group (both P > .05).
Endotracheal intubation-related CA occurred higher than commonly recognized, and patient outcomes were not better than other causes of CA. These data highlight the importance of efforts to prevent intubation-related CA. However, further prospective larger study will be required to generalize this result.
紧急气管插管相关的心搏骤停（CA）尚无充分记录。本研究比较了插管相关CA与其他院内CA病因的临床特征及预后。
所有研究患者均为2007年1月至2011年12月期间在急诊科发生CA的连续成年患者（≥18岁）。紧急气管插管相关CA定义为在成功插管后20分钟内发生。比较插管相关CA患者与非插管相关CA患者的临床变量。主要结局为良好的神经学结局，定义为脑功能分类评分为1至2分。次要结局为存活至出院。
在251例发生CA的患者中，41例因创伤相关CA或“不进行心肺复苏”方案而被排除，从而留下210例患者。插管相关CA的患病率为23.3%，成功插管至CA的中位持续时间为5.0分钟（四分位间距，2.0 - 9.5）。与其他CA病因的患者相比，插管相关CA组更常出现无脉电活动作为首次心搏骤停节律（75.5%对59.0%；P = .03）。然而，插管相关CA组良好神经学结局的发生率（14.3%对21.1%）和存活至出院的发生率（34.7%对35.4%）均无显著更高（P均>.05）。
气管插管相关CA的发生率高于普遍认知，患者预后并不优于其他CA病因。这些数据凸显了预防插管相关CA努力的重要性。然而，需要进一步进行前瞻性更大规模研究以推广这一结果。
