Peri-intubation cardiac arrest in the Emergency Department: A National Emergency Airway Registry (NEAR) study

Araña, Allyson A.; Reynolds, Joshua C.; Davis, William T.; Schauer, Steven G; Oliver, Joshua J.; Summers, Shane M.; Long, Brit; Walls, Ron M.; Brown, Calvin A.; April, Michael D.; Carlson, Jestin N.; Chan, Eugene Y.; Driver, Brian E.; Fix, Megan L.; Gatewood, Medley; Hansen, Matthew; Hurley, Bruce; Kaji, Amy H.; Kilgo, Bob; Lauerman, Nicholas; Lutfy-Clayton, Lucienne; Miller, Sharon; Murray, Matthew; Nguyen, Margaret; Riordan, John; Runde, Daniel; Sandefur, Benjamin J.; Severyn, Fred A.; Shochat, Guy; Trent, Stacy A.; Wilcox, Susan R.

doi:10.1016/j.resuscitation.2021.02.039

Cited by 48 publications

(39 citation statements)

References 23 publications

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“…Kim et al [7] reported that the proportion of survival to discharge was 24.60% and that the rate of favorable neurological outcomes at discharge was 20.32%. The incidence of endotracheal intubation (ETI)-related CA in the ED varied significantly from 1.7% to 23.3% [25,26]. EDCA episodes occurring during or post-intubation was the common reason in the ED.…”

Section: Discussionmentioning

confidence: 99%

Prognostic factors for adults with cardiac arrest in the emergency department: a retrospective cohort study

2021

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Cardiac arrest in the emergency department is associated with the following three scenarios: out-of-hospital cardiac arrest, primary emergency department cardiac arrest (EDCA), and patients transferred from other hospitals after the return of spontaneous circulation from cardiac arrest. Among them, the primary cardiac arrest episode in the emergency department has been less studied. This aim of this study was to explore patient characteristics and the relationship between causes of EDCA and survival outcomes according to different patient management strategies. The main finding of this study was that EDCA with Cardiogenic etiology was associated with higher survival to discharge (OR: 2.31; 95% CI: 1.59–3.91) and discharged neurological outcome (OR: 2.84; 95% CI: 1.57–5.97). More favorable discharged neurological outcome were also found in EDCA patients with initial shockable rhythm (OR: 4.83; 95% CI: 2.33–10.01) and shorter resuscitation time (≤11.5 min, OR: 3.62; 95% CI: 1.57–8.32). EDCA patients under sedative medication (OR: 0.24; 95% CI: 0.10–0.59) and ventilator support by intubation before EDCA episode (OR: 0.26; 95% CI: 0.09–0.75) had poor neurological outcome. We conclude that EDCA patients with cardiogenic etiology have more favorable survival to discharge and discharged neurological outcomes. Prolonged CPR time during EDCA, post-intubation status and sedative medication use were prognostic factors of negative survival and neurological outcomes.

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Section: Discussionmentioning

confidence: 99%

Prognostic factors for adults with cardiac arrest in the emergency department: a retrospective cohort study

2021

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“…Cardiac arrest is a notorious fatal complication of emergent airway management in the ED. The incidence is 0.5-4.2% and is associated with peri-intubation conditions, procedural processes and pharmacological effects of rapid sequential intubation [37]. The occurrence of peri-intubation cardiac arrest has increased in-hospital mortality, so prevention is important [38].…”

Section: Peri-intubation Cardiac Arrestmentioning

confidence: 99%

Qualitative and quantitative analysis of emergency department cardiac arrest publications

2021

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Cardiac arrest is a medical emergency with a poor prognosis. Patient characteristics and outcomes are associated with location and are traditionally categorized into out-of-hospital cardiac arrest (OHCA) or in-hospital cardiac arrest (IHCA). Increasing evidence has revealed that cardiac arrest occurring in the emergency department is distinct from OHCA or IHCA in other locations in hospitals, but most academic publications combine these populations and apply the knowledge arising from OHCA or IHCA to patients with emergency department cardiac arrest (EDCA). The aim of this study was to identify the research direction of EDCA in the past 20 years and to analyze the characteristics and content of academic publications. We searched the MEDLINE and EMBASE databases for eligible articles until May 30, 2021. Two independent reviewers extracted data by using a customized form to record crucial information, and any conflicts between the two reviewers were resolved through discussion with another independent reviewer. The aggregated data underwent a scoping review and analyzed qualitatively and quantitatively. In total, 52 original articles investigating EDCA were included; only 15 articles simply focused on EDCA, while other articles involved OHCA or IHCA simultaneously. There were 3 articles discussing the relationship of overcrowdedness and EDCA, 12 articles for prediction and risk factors associated with EDCA, 15 articles for epidemiology and prognosis, and 22 articles for specific diagnostic or resuscitation skills with regard to EDCA. Studies focusing on EDCA are increasing but still scarce. Applying the knowledge arising from OHCA or IHCA to EDCA is questionable, and research focused on EDCA is necessary. ED overcrowdedness-associated EDCA and prediction models for EDCA are essential topics that need further investigation.

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“…Video laryngoscopes are increasingly the most common devices used for tracheal intubation in US emergency departments (EDs). 1 Video laryngoscopy (VL) has consistently been reported to improve glottic visualization compared with direct laryngoscopy (DL). 2 , 3 , 4 When incorporated into high‐volume training programs, there is some evidence that emergency medicine residents acquire airway skills better with a video laryngoscope.…”

Section: Introductionmentioning

confidence: 99%

Video screen visualization patterns when using a video laryngoscope for tracheal intubation: A systematic review

Dean

Kerrey

2022

JACEP Open

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Objective Published studies of video laryngoscopes are often limited by the lack of a clear definition of video laryngoscopy (VL). We performed a systematic review to determine how often published studies of VL report on video screen visualization. Methods We searched PubMed, EMBASE and Scopus for interventional and observational studies in which a video laryngoscope equipped with a standard geometry blade was used for tracheal intubation. We excluded simulation based studies. Our primary outcome was data on video laryngoscope screen visualization. Secondary outcomes were explicit methodology for screen visualization. Results We screened 4838 unique studies and included 207 (120 interventional and 87 observational). Only 21 studies (10% of 207) included any data on video screen visualization by the proceduralist, 19 in a yes/no fashion only (ie, screened viewed or not) and 2 with detail beyond whether the screen was viewed or not. In 11 more studies, visualization patterns could be inferred based on screen availability and in 16 more studies, the methods section stated how screen visualization was expected to be performed without reporting data collection on how the proceduralist interacted with the video screen. Risk of bias was high in the majority of included studies. Conclusions Published studies of VL, including many clinical trials, rarely include data on video screen visualization. Given the nuances of using a video laryngoscope, this is a critical deficiency, which largely prevents us from knowing the treatment effect of using a video laryngoscope in clinical practice. Future studies of VL must address this deficiency.

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Peri-intubation cardiac arrest in the Emergency Department: A National Emergency Airway Registry (NEAR) study

Cited by 48 publications

References 23 publications

Prognostic factors for adults with cardiac arrest in the emergency department: a retrospective cohort study

Prognostic factors for adults with cardiac arrest in the emergency department: a retrospective cohort study

Qualitative and quantitative analysis of emergency department cardiac arrest publications

Video screen visualization patterns when using a video laryngoscope for tracheal intubation: A systematic review

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