Meelarp Nattikarn, Wongtanasarasin Wachira
Department of Emergency Medicine, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand.
Department of Emergency Medicine, UC Davis School of Medicine, Sacramento, CA, USA.
Turk J Emerg Med. 2025 Apr 1;25(2):130-138. doi: 10.4103/tjem.tjem_232_24. eCollection 2025 Apr-Jun.
Various studies have delved into its incidence and risk factors, but a comprehensive meta-analysis exploring this life-threatening complication during emergent endotracheal intubation has been lacking. This study quantitatively assesses the global incidence and associated risk factors of peri-intubation cardiac arrest (PICA).
We conducted a systematic literature search on PubMed, Embase, Web of Science, and Cochrane Library from inception to October 28, 2024. Two independent authors searched, reviewed, and evaluated selected studies. Any peer-reviewed published studies reporting the incidence of PICA among adults (≥18 years) outside of the operating theater were included. Studies reporting incidence within heterogeneous populations or from overlapping groups were excluded. The primary outcome focused on determining the global incidence of PICA, while the secondary outcome addressed associated risk factors. A random-effects model was used to aggregate overall incidence rates. Subgroup analysis and meta-regression were conducted to examine PICA incidence in different locations and with the study's sample size. The publication bias was assessed via Egger's test and visualization of the funnel plot. The risk of bias was evaluated using the Joanna Briggs Institute Critical Appraisal Checklist.
Fifteen articles met the inclusion criteria for the meta-analysis. PICA incidence varied from 0.5% to 23.3%. The estimated pooled incidence was 2.7% (95% confidence interval [CI]: 1.9-3.6) across PICA in the emergency department (ED) (2.5%, 95% CI: 1.4-3.7) and outside of the ED (2.9%, 95% CI: 2.2-3.6). Egger's test yielded = 0.009, indicating potential publication bias due to small-study effects, as suggested by the funnel plot. Meta-regression analysis revealed higher incidence in studies with smaller populations. Notably, preintubation hypotension, hypoxemia, and body mass index were found to be the most associated risk factors for PICA. Additionally, there was significant variability in PICA definitions, ranging from immediate to occurrences within 60 min after intubation.
PICA occurrences during emergent endotracheal intubation reached up to 3%, showing a similar rate both within and outside the ED. While limitations such as heterogeneity and potential bias exist, these findings underscore the imperative for prospective research. Prospective studies are warranted to further delineate this critical aspect of emergent intubation.
多项研究已深入探讨其发生率和风险因素，但缺乏一项全面的荟萃分析来探究紧急气管插管期间这种危及生命的并发症。本研究定量评估了插管周围心脏骤停（PICA）的全球发生率及相关风险因素。
我们对PubMed、Embase、Web of Science和Cochrane图书馆进行了系统的文献检索，检索时间跨度从数据库建立至2024年10月28日。两名独立作者对选定的研究进行检索、审查和评估。纳入任何报告手术室以外成年人（≥18岁）中PICA发生率的同行评审发表研究。排除报告异质人群或重叠组内发生率的研究。主要结局侧重于确定PICA的全球发生率，次要结局涉及相关风险因素。采用随机效应模型汇总总体发生率。进行亚组分析和meta回归以检查不同地点以及根据研究样本量的PICA发生率。通过Egger检验和漏斗图可视化评估发表偏倚。使用乔安娜·布里格斯研究所批判性评价清单评估偏倚风险。
15篇文章符合荟萃分析的纳入标准。PICA发生率从0.5%到23.3%不等。急诊科（ED）内PICA的估计合并发生率为2.5%（95%置信区间[CI]：1.4 - 3.7），ED外为2.9%（95% CI：2.2 - 3.6），总体估计合并发生率为2.7%（95% CI：1.9 - 3.6）。Egger检验得出P = 0.009，如漏斗图所示，表明存在因小研究效应导致的潜在发表偏倚。Meta回归分析显示人群规模较小的研究中发生率较高。值得注意的是，插管前低血压、低氧血症和体重指数被发现是PICA最相关的风险因素。此外，PICA的定义存在显著差异，范围从插管后立即发生到60分钟内发生。
紧急气管插管期间PICA的发生率高达3%，在ED内和ED外显示出相似的发生率。虽然存在异质性和潜在偏倚等局限性，但这些发现强调了前瞻性研究的必要性。有必要进行前瞻性研究以进一步阐明紧急插管的这一关键方面。
