Park Chul
Division of Pulmonary Medicine, Department of Internal Medicine, Wonkwang University Hospital, Iksan, Korea.
Acute Crit Care. 2019 Aug;34(3):212-218. doi: 10.4266/acc.2019.00598. Epub 2019 Aug 31.
Peri-intubation cardiac arrest (PICA) following emergent endotracheal intubation (ETI) is a rare, however, potentially preventable type of cardiac arrest. Limited published data have described factors associated with inpatient PICA and patient outcomes. The aim of this study was to identify risk factors associated with PICA among hospitalized patients emergently intubated at a general ward as compared to non-PICA inpatients. In addition, we identified a difference of clinical outcomes in patients between PICA and other types of inpatient cardiac arrest (OTICA).
We conducted a retrospective observational study of patients at two institutions between January 2016 to December 2017. PICA was defined in patients emergently intubated who experienced cardiac arrest within 20 minutes after ETI. The non-PICA group consisted of inpatients emergently intubated without cardiac arrest. Risk factors for PICA were identified through univariate and multivariate logistic regression analysis. Clinical outcomes were compared between PICA and OTICA.
Fifteen episodes of PICA occurred during the study period, accounting for 3.6% of all inpatient arrests. Intubation-related shock index, number of intubation attempts, pre-ETI vasopressor use, and neuromuscular blocking agent (NMBA) use, especially succinylcholine, were independently associated with PICA. Clinical outcomes of intensive care unit and hospital length of stay, survival to discharge, and neurologic outcome at hospital discharge were not significantly different between PICA and OTICA.
We identified four independent risk factors for PICA, and preintubation hemodynamic stabilization and avoidance of NMBA were possibly correlated with a decreased PICA risk. Clinical outcomes of PICA were similar to those of OTICA.
紧急气管插管（ETI）后发生的围插管期心脏骤停（PICA）是一种罕见但有可能预防的心脏骤停类型。已发表的有限数据描述了与住院患者PICA及患者预后相关的因素。本研究的目的是确定在普通病房接受紧急插管的住院患者中与PICA相关的危险因素，并与非PICA住院患者进行比较。此外，我们还确定了PICA患者与其他类型的住院心脏骤停（OTICA）患者临床结局的差异。
我们对2016年1月至2017年12月期间两家机构的患者进行了一项回顾性观察研究。PICA定义为在ETI后20分钟内发生心脏骤停的紧急插管患者。非PICA组由紧急插管但未发生心脏骤停的住院患者组成。通过单因素和多因素逻辑回归分析确定PICA的危险因素。比较PICA和OTICA的临床结局。
研究期间发生了15例PICA，占所有住院患者心脏骤停的3.6%。插管相关休克指数、插管尝试次数、ETI前使用血管升压药以及使用神经肌肉阻滞剂（NMBA），尤其是琥珀酰胆碱，均与PICA独立相关。PICA和OTICA在重症监护病房的临床结局、住院时间、出院生存率及出院时的神经学结局方面无显著差异。
我们确定了PICA的四个独立危险因素，插管前血流动力学稳定和避免使用NMBA可能与降低PICA风险相关。PICA的临床结局与OTICA相似。
