Department of Emergency Medicine, Chang Gung Memorial Hospital at Linkou, Taoyuan, Taiwan.
Department of Pharmacy, Chang Gung Memorial Hospital at Keelung, Keelung, Taiwan.
Biomed J. 2024 Jun;47(3):100656. doi: 10.1016/j.bj.2023.100656. Epub 2023 Sep 1.
Peri-intubation cardiac arrest (PICA) is an uncommon yet serious complication of intubation. Although some associated risk factors have been identified, the results have been inconsistent. The aim of this study was to systematically review the relevant research and examine the associated risk factors of PICA through meta-analysis.
Studies examining the risk factors for PICA before 1 Nov. 2022 were identified through searches in MEDLINE (OvidSP) and EMBASE. The reported adjusted or unadjusted odds ratios (ORs) and risk ratios (RRs) were recorded. We calculated pooled ORs and created forest plots using a random-effects model to identify the statistically significant risk factors. We assessed the certainty of evidence for each risk factor.
Eight studies were included in the meta-analysis. Pre-intubation hypotension, with a pooled OR of 4.96 (95% confidence interval [C.I.]: 3.75-6.57), pre-intubation hypoxemia, with a pooled OR of 4.43 (95% C.I.: 1.24-15.81), and two or more intubation attempts, with a pooled OR of 1.88 (95% C.I.: 1.09-3.23) were associated with a significantly higher risk of PICA. The pooled incidence of PICA was 2.1% (95% C.I.: 1.5%-3.0%).
Pre-intubation hypotension, hypoxemia, and more intubation attempts are significant risk factors for PICA. The findings could help physicians identify patients at risk under the acute setting.
围插管期心脏骤停（PICA）是插管的一种罕见但严重的并发症。虽然已经确定了一些相关的危险因素，但结果并不一致。本研究旨在通过荟萃分析系统地回顾相关研究，并检查 PICA 的相关危险因素。
在 2022 年 11 月 1 日之前，通过在 MEDLINE（OvidSP）和 EMBASE 中进行检索，确定了研究 PICA 危险因素的研究。记录了报告的调整后或未调整的比值比（OR）和风险比（RR）。我们使用随机效应模型计算了汇总 OR 并创建了森林图，以确定具有统计学意义的危险因素。我们评估了每个危险因素的证据确定性。
有 8 项研究纳入荟萃分析。围插管期低血压，汇总 OR 为 4.96（95%置信区间[CI]：3.75-6.57），围插管期低氧血症，汇总 OR 为 4.43（95%CI：1.24-15.81），以及两次或两次以上插管尝试，汇总 OR 为 1.88（95%CI：1.09-3.23），与 PICA 的风险显著增加相关。PICA 的汇总发生率为 2.1%（95%CI：1.5%-3.0%）。
围插管期低血压、低氧血症和更多次插管尝试是 PICA 的显著危险因素。这些发现可以帮助医生在急性环境下识别出有风险的患者。
