Cardiac Arrests Associated With Tracheal Intubations in PICUs: A Multicenter Cohort Study*

Shiima, Yuko; Berg, Robert A.; Bogner, Hillary R.; Morales, Knashawn H.; Nadkarni, Vinay; Nishisaki, Akira

doi:10.1097/ccm.0000000000001741

Cited by 53 publications

(50 citation statements)

References 37 publications

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“…Detailed study design and data collection for the APRICOT study were previously published. 10 In summary, the APRICOT study prospectively collected perioperative data that described the anaesthesia management of consecutive children aged from birth to age 15 yr during a consecutive 2-week period between April 1, 2014 and January 31, 2015. All participating centres applied for formal ethics approval or a waiver, as appropriate, as ethics requirements varied between centres and countries.…”

Section: Methodsmentioning

confidence: 99%

“…9 This study provided detailed information on airway management and modes of ventilation across the different age groups, in 33 countries and 261 institutions. Considering that the choice of paediatric airway management remains highly individualised and is dictated by personal preference and local resources, 5,10 characterisation of current practices in Europe is of utmost importance to harmonise clinical practice and potentially improve patient outcome.…”

mentioning

confidence: 99%

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Airway management in paediatric anaesthesia in Europe—insights from APRICOT (Anaesthesia Practice In Children Observational Trial): a prospective multicentre observational study in 261 hospitals in Europe

Engelhardt

Virág

Veyckemans

et al. 2018

British Journal of Anaesthesia

104

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Section: Methodsmentioning

confidence: 99%

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confidence: 99%

Airway management in paediatric anaesthesia in Europe—insights from APRICOT (Anaesthesia Practice In Children Observational Trial): a prospective multicentre observational study in 261 hospitals in Europe

Engelhardt

Virág

Veyckemans

et al. 2018

British Journal of Anaesthesia

104

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“…This practice varies across the ICUs, since it depends on the anesthesiology service model for their ICU patients. In one study evaluating risk factors for tracheal intubation–associated cardiac arrests, the patient hemodynamics (shock state) and respiratory failure had more weights (adjusted OR 6.6 for shock state, adjusted OR 4.3 for respiratory failure) than difficult airway features (adjusted OR 2.1) . This highlights that the risk of airway management in the ICU and ED is often dictated by the patient's systemic condition.…”

Section: Airway Management In the Pediatric Icu Emergency Departmentmentioning

confidence: 99%

Normal and difficult airways in children: “What’s New”—Current evidence

Fiadjoe

Nishisaki

2020

Pediatric Anesthesia

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Background Pediatric difficult airway is one of the most challenging clinical situations. We will review new concepts and evidence in pediatric normal and difficult airway management in the operating room, intensive care unit, Emergency Department, and neonatal intensive care unit. Methods Expert review of the recent literature. Results Cognitive factors, teamwork, and communication play a major role in managing pediatric difficult airway. Earlier studies evaluated videolaryngoscopes in a monolithic way yielding inconclusive results regarding their effectiveness. There are, however, substantial differences among videolaryngoscopes particularly angulated vs. nonangulated blades which have different learning and use characteristics. Each airway device has strengths and weaknesses, and combining these devices to leverage both strengths will likely yield success. In the pediatric intensive care unit, emergency department and neonatal intensive care units, adverse tracheal intubation–associated events and hypoxemia are commonly reported. Specific patient, clinician, and practice factors are associated with these occurrences. In both the operating room and other clinical areas, use of passive oxygenation will provide additional laryngoscopy time. The use of neuromuscular blockade was thought to be contraindicated in difficult airway patients. Newer evidence from observational studies showed that controlled ventilation with or without neuromuscular blockade is associated with fewer adverse events in the operating room. Similarly, a multicenter neonatal intensive care unit study showed fewer adverse events in infants who received neuromuscular blockade. Neuromuscular blockade should be avoided in patients with mucopolysaccharidosis, head and neck radiation, airway masses, and external airway compression for anticipated worsening airway collapse with neuromuscular blocker administration. Conclusion Clinicians caring for children with difficult airways should consider new cognitive paradigms and concepts, leverage the strengths of multiple devices, and consider the role of alternate anesthetic approaches such as controlled ventilation and use of neuromuscular blocking drugs in select situations. Anesthesiologists can partner with intensive care and emergency department and neonatology clinicians to improve the safety of airway management in all clinical settings.

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“…In a prospective multicenter PICU study, tracheal intubation–associated CPA occurred in 1.7% of 5,232 tracheal intubation attempts (14). However, this prior study included stable patients intubated for elective procedures with optimal preparation, whereas the patients in our cohort were all emergently intubated for ARC, and likely represent a very different risk profile that could explain the discrepant rates of cardiac arrest.…”

Section: Discussionmentioning

confidence: 99%

“…In adult patients, ARC events requiring tracheal intubation are associated with an increased risk of progression to CPA (7–13). Similarly, children who require emergency tracheal intubation have a markedly increased risk of progression to CPA (14, 15). …”

mentioning

confidence: 99%

Failure of Invasive Airway Placement on the First Attempt Is Associated With Progression to Cardiac Arrest in Pediatric Acute Respiratory Compromise*

Stinson

Srinivasan

Topjian

et al. 2018

Pediatric Critical Care Medicine

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Objectives: The aim of this study was to describe the proportion of acute respiratory compromise events in hospitalized pediatric patients progressing to cardiopulmonary arrest, and the clinical factors associated with progression of acute respiratory compromise to cardiopulmonary arrest. We hypothesized that failure of invasive airway placement on the first attempt (defined as multiple attempts at tracheal intubation, and/or laryngeal mask airway placement, and/or the creation of a new tracheostomy or cricothyrotomy) is independently associated with progression of acute respiratory compromise to cardiopulmonary arrest. Design: Multicenter, international registry of pediatric in-hospital acute respiratory compromise. Setting: American Heart Association’s Get with the Guidelines-Resuscitation registry (2000–2014). Patients: Children younger than 18 years with an index (first) acute respiratory compromise event. Interventions: None. Measurements and Main Results: Of the 2,210 index acute respiratory compromise events, 64% required controlled ventilation, 26% had return of spontaneous ventilation, and 10% progressed to cardiopulmonary arrest. There were 762 acute respiratory compromise events (34%) that did not require an invasive airway, 1,185 acute respiratory compromise events (54%) with successful invasive airway placement on the first attempt, and 263 acute respiratory compromise events (12%) with failure of invasive airway placement on the first attempt. After adjusting for confounding variables, failure of invasive airway placement on the first attempt was independently associated with progression of acute respiratory compromise to cardiopulmonary arrest (adjusted odds ratio 1.8 [95% CIs, 1.2–2.6]). Conclusions: More than 1 in 10 hospitalized pediatric patients who experienced an acute respiratory compromise event progressed to cardiopulmonary arrest. Failure of invasive airway placement on the first attempt is independently associated with progression of acute respiratory compromise to cardiopulmonary arrest. (Pediatr Crit Care Med 2017; XX:00–00)

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Cardiac Arrests Associated With Tracheal Intubations in PICUs: A Multicenter Cohort Study*

Cited by 53 publications

References 37 publications

Airway management in paediatric anaesthesia in Europe—insights from APRICOT (Anaesthesia Practice In Children Observational Trial): a prospective multicentre observational study in 261 hospitals in Europe

Airway management in paediatric anaesthesia in Europe—insights from APRICOT (Anaesthesia Practice In Children Observational Trial): a prospective multicentre observational study in 261 hospitals in Europe

Normal and difficult airways in children: “What’s New”—Current evidence

Failure of Invasive Airway Placement on the First Attempt Is Associated With Progression to Cardiac Arrest in Pediatric Acute Respiratory Compromise*

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