| The incidence and risk factors for cardiac arrest during emergency tracheal intubation: a justification for incorporating the ASA Guidelines in the remote location. | |
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MedLine Citation:
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PMID: 15590254 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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STUDY OBJECTIVE: To determine the incidence and etiology of cardiopulmonary arrest during emergency intubation in the remote location by comparing two periods (1990-1995 vs. 1995-2002) at the same institution to assess whether immediate access to advanced airway devices and endotracheal tube-verifying devices altered the incidence of hypoxemia-driven cardiac arrest. DESIGN: Retrospective review of a quality improvement (QI) database for emergency intubation outside the operating room (OR). SETTING: 765-bed tertiary care, level 1 trauma center. PATIENTS: 3035 critically ill patients suffering from cardiopulmonary, traumatic, septic, metabolic, or neurological-based deterioration and requiring emergency airway management. MEASUREMENTS: Rate of cardiac arrest, as defined as asystole, bradycardia, or ventricular dysrhythmia with non-measurable blood pressure during or within 5 minutes of intubation, requiring cardiopulmonary resuscitation (CPR), were measured. MAIN RESULTS: 60 cardiac arrests were documented (2%, or one per 50 cases), 83% of which were associated with profound hypoxemia (oxygen saturation <70%) during the airway procedure. Esophageal intubation was a frequent complication (n = 38; 63%), often leading to hypoxemia (97%) and regurgitation (67%). The overall rate of cardiac arrest was reduced 50% between the two time periods (2.8%: 1990-1995 period and 1.4%: 1995-2002 period). The relative risk estimate for complications in a match cohort contributing to the etiology of cardiac arrest included hypoxemia (4X), regurgitation (28X), aspiration (22X), bradycardia (23X) (all P < 0.003), and esophageal intubation (7X), P < 0.04). A total of 34% patients survived less than 24 hours and 31% survived to be discharged. CONCLUSION: Cardiac arrest during emergency tracheal intubation outside the OR is relatively common compared with the OR environment. Airway-related complications played a prominent role, either singly or in combination with the patient's underlying physiological state. Immediate access to advanced airway devices and endotracheal tube-verifying devices appear to have a significant impact on the incidence of hypoxemia-driven cardiac arrest. |
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Authors:
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Thomas C Mort |
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Publication Detail:
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Type: Journal Article |
Journal Detail:
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Title: Journal of clinical anesthesia Volume: 16 ISSN: 0952-8180 ISO Abbreviation: J Clin Anesth Publication Date: 2004 Nov |
Date Detail:
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Created Date: 2004-12-13 Completed Date: 2005-07-19 Revised Date: 2007-11-15 |
Medline Journal Info:
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Nlm Unique ID: 8812166 Medline TA: J Clin Anesth Country: United States |
Other Details:
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Languages: eng Pagination: 508-16 Citation Subset: IM |
Affiliation:
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Department of Anesthesiology, Hartford Hospital, Hartford, CT 06015, USA. TMORT@harthosp.org |
Export Citation:
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| MeSH Terms | |
Descriptor/Qualifier:
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Adolescent Adult Aged Aged, 80 and over Airway Obstruction / complications Critical Illness Emergency Treatment* Female Heart Arrest / epidemiology*, etiology Hemodynamics Humans Intubation, Intratracheal / adverse effects* Logistic Models Male Middle Aged Practice Guidelines as Topic Questionnaires Retrospective Studies Risk Factors |
From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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