Prevalence and outcomes of endotracheal intubation ...

4 downloads 0 Views 219KB Size Report
Results: Of the 251 patients who developed CA, 41 were excluded due to trauma-related CA or “do-not-resuscitate” protocols, thereby leaving 210 patients.
    Prevalence and Outcomes of Endotracheal Intubation-Related Cardiac Arrest in the Emergency Department Byuk Sung Ko MD, Ryeok Ahn MD, Seung Mok Ryoo MD, Shin Ahn MD, Chang Hwan Sohn MD, Dong Woo Seo MD, PhD, Kyoung Soo Lim MD, PhD, Won Young Kim MD, PhD PII: DOI: Reference:

S0735-6757(15)00639-7 doi: 10.1016/j.ajem.2015.07.083 YAJEM 55208

To appear in:

American Journal of Emergency Medicine

Received date: Revised date: Accepted date:

29 June 2015 30 July 2015 31 July 2015

Please cite this article as: Ko Byuk Sung, Ahn Ryeok, Ryoo Seung Mok, Ahn Shin, Sohn Chang Hwan, Seo Dong Woo, Lim Kyoung Soo, Kim Won Young, Prevalence and Outcomes of Endotracheal Intubation-Related Cardiac Arrest in the Emergency Department, American Journal of Emergency Medicine (2015), doi: 10.1016/j.ajem.2015.07.083

This is a PDF file of an unedited manuscript that has been accepted for publication. As a service to our customers we are providing this early version of the manuscript. The manuscript will undergo copyediting, typesetting, and review of the resulting proof before it is published in its final form. Please note that during the production process errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain.

ACCEPTED MANUSCRIPT Original article

RI P

Emergency Department

T

Prevalence and Outcomes of Endotracheal Intubation-Related Cardiac Arrest in the

Byuk Sung Ko, M.D.*1, Ryeok Ahn, M.D*.2, Seung Mok Ryoo, M.D.1, Shin Ahn, M.D.1, Chang

SC

Hwan Sohn, M.D.1; Dong Woo Seo, M.D., Ph.D.1, Kyoung Soo Lim, M.D., Ph.D.1; Won

1

MA NU

Young Kim, M.D., Ph.D.1,*

Department of Emergency Medicine, Ulsan University College of Medicine, Asan Medical

Center, Seoul, Korea

Department of Emergency Medicine, Ulsan University College of Medicine, Ulsan, Korea

ED

2

* These authros contributed equally to this work

PT

Running title: Endotracheal intubation-related cardiac arrest

Correspondence: Won Young Kim, MD, PhD

AC

*

CE

The Authors declare that there is no conflict and financial funding.

Department of Emergency Medicine, Ulsan University College of Medicine, Asan Medical Center, 86 Asanbyeongwon-gil, Songpa-gu, Seoul 138-736, Korea. Tel.: +82-2-3010-3350; Fax: +82-2-3010-3360; Email: [email protected] Key Words: Intubation; Airway management; Complication; Cardiac arrest; Outcomes Abbreviations: CA, cardiac arrest; CPC, cerebral performance category; CPR, cardiopulmonary resuscitation; ROSC, return of spontaneous circulation.

1

ACCEPTED MANUSCRIPT Abstract: Background: Emergency endotracheal intubation-related cardiac arrest (CA) is not well documented. This study compares the clinical features and outcomes of intubation-

T

related CA and other causes of in-hospital CA. Methods: All study patients were consecutive

RI P

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

SC

within 20 minutes after successful intubation. Clinical variables were compared between

MA NU

patients with intubation-related CA and intubation-unrelated CA. The primary outcome was a good neurological outcome defined as a cerebral performance category score of 1–2. The secondary outcome was survival to hospital discharge. Results: Of the 251 patients who developed CA, 41 were excluded due to trauma-related CA or ‘do not resuscitate’ protocols,

ED

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 =

PT

2.0–9.5). Pulseless electrical activity was more commonly noted as the first arrest rhythm in

CE

the intubation-related CA group (75.5% vs 59.0%; p=0.03) compared with patients with other causes of CA. However, the rates of good neurological outcomes (14.3% vs 21.1%) and

AC

survival to discharge (34.7% vs 35.4%) were not significantly higher in intubation-related CA group (both p > 0.05). Conclusion: 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. Key Indexing Terms: Intubation; Airway management; Complication; Cardiac arrest; Outcomes

2

ACCEPTED MANUSCRIPT INTRODUCTION Determining the prognosis according to the cause of cardiac arrest can be challenging in

RI P

could help guide patient management and the goals of care.[2]

T

many cases.[1] However, more accurate information regarding the prognosis of cardiac arrest

Emergency endotracheal intubation to critically ill patients can be fraught with severe

SC

life-threatening complications, including hypoxemia, hypotension, arrhythmia, and even

MA NU

cardiac arrest (CA).[3-10] Nonetheless, physicians seem to have underestimated prognosis of intubation related CA and literatures have not been interested in such a serious complication.[11] One study has reported that the incidence of intubation-related CA may be higher than commonly appreciated and is associated with hospital deaths.[12] However, the

ED

clinical features and prognosis of intubation-related CA in comparison with other causes of in-hospital CA remain unclear. This study describes and compares the clinical features and

PT

outcomes of patients with emergency endotracheal intubation-related CA and other causes of

AC

CE

in-hospital CA that developed in the emergency department.

3

ACCEPTED MANUSCRIPT METHODS Study design and population

T

This retrospective, single-center cohort study was conducted at Asan Medical Center, a

RI P

2800-bed, university-affiliated, tertiary referral center in Seoul, Korea. We included consecutive adult patients (≥18 years) who developed CA in the emergency department

SC

between January 2007 and December 2011. Exclusion criteria included age