The incidence and risk factors for cardiac arrest during emergency tracheal intubation: A justification for incorporating the ASA Guidelines in the remote location

Mort, Thomas C.

doi:10.1016/j.jclinane.2004.01.007

Cited by 241 publications

(198 citation statements)

References 33 publications

(67 reference statements)

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“…Furthermore, ETI was one of the most important independent predictors of mortality at multivariate analysis. The reasons of these findings are not completely clear but it could be hypothesized that an important role could be represented by the physiopathological changes induced by ETI itself, including hypotension, iatrogenic hypoxia and bradyarrhythmias [18][19][20][21][22] and by the major complications associated with it, like unrecognized oesophageal intubation, aspiration and pneumothorax [18,19,23]. In a series of 1954 patients received ETI, Wang and coll.…”

Section: Discussionmentioning

confidence: 99%

Endotracheal intubation and outcome in high-risk patients with acute myocardial infarction undergoing primary angioplasty

Tomassini¹,

Gagnor²,

Montali³

et al. 2014

J Anesthesiol Clin Sci

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Background: Patients with acute myocardial infarction (AMI) who undergo endotracheal intubation (ETI) are at high risk for mortality, but the outcome of those patients submitted to primary angioplasty (PCI) has not yet clearly reported. Methods:We collected data about all consecutive patients with AMI within 12 hours who underwent primary PCI and analyzed clinical and procedural characteristics as well as in-hospital mortality of ETI compared to no-ETI patients. Results: From September 2001 to June 2010, 1251 patients underwent primary PCI and 99 (7.9%) of them underwent ETI. ETI patients were more likely to be hypertensive (76.8% vs 67.8%, p=0.003), diabetic 43.4% vs 17.9%, p<0.0001), resuscitated by cardiac arrest (68.7% vs 0.7%, p<0.0001), to present with cardiogenic shock (CS) (61.6% % vs 8.1%, p<0.0001), with a lower left ventricular ejection fraction (LVEF) (38.9±9.4% vs 48.9±9.2%, p<0.0001) and to be treated with intra-aortic balloon counterpulsation (IABP) (60.1% vs 15.4%, p<0.0001). The in-hospital mortality was higher in ETI patients (37.4% vs 4.3%, p<0.0001) and they were more likely to undergo stent thrombosis (3% vs 0.34%, p=0.006). After using the propensity score modelling. Considering the risk profile, ETI was associated to higher in hospital mortality in the patients at higher risk (39.8% vs 18.5%, p=0.003). Moreover, ETI was one of the most powerful predictors of in-hospital mortality at multivariate analysis (OR 37.04, 95% CI 6.0-228.45, p=0.0001). Conclusions: ETI was found to be an independent predictor of mortality in high-risk AMI patients undergoing primary angioplasty. The implications for current clinical care remained undefined.

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Section: Discussionmentioning

confidence: 99%

Endotracheal intubation and outcome in high-risk patients with acute myocardial infarction undergoing primary angioplasty

Tomassini¹,

Gagnor²,

Montali³

et al. 2014

J Anesthesiol Clin Sci

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“…These surgical procedures are performed by otolaryngologists, general surgeons, thoracic surgeons and neurosurgeons. Cricothyrotomy and tracheostomy are essential intervention for patients in critical conditions or injured patients, such as following maxillofacial trauma, cranial trauma and multi-organ injury, and it provides improved care for patients in the trauma or critical care setting and reduced the hospital and patient costs 10,[14][15][16]19) . These procedures are also indicated in patients with difficult airway.…”

Section: Discussionmentioning

confidence: 99%

Clinically Correlated Anatomical Basis of Cricothyrotomy and Tracheostomy

Gülşen

Ünal

Dinç

et al. 2010

J Korean Neurosurg Soc

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J Korean Neurosurg Soc 47 : 174-179, 2010Objective : Cricothyrotomy and tracheostomy are performed by physicians in various disciplines. It is important to know the comprehensive anatomy of the laryngotracheal region. Hemorrhage, esophageal injury, recurrent laryngeal nerve injury, pneumothorax, hemothorax, false passage of the tube and tracheal stenosis after decannulation are well known complications of the cricothyrotomy and tracheostomy. Cricothyrotomy and tracheostomy should be performed without complications and as quickly as possible with regards the patients' clinical condition. Methods : A total of 40 cadaver necks were dissected in this study. The trachea and larynx and the relationship between the trachea and larynx and the surrounding structures was investigated. The tracheal cartilages and annular ligaments were counted and the relationship between tracheal cartilages and the thyroid gland and vascular structures was investigated. We performed cricothyrotomy and tracheostomy in eleven cadavers while simulating intensive care unit conditions to determine the duration of those procedures. Results : There were 11 tracheal cartilages and 10 annular ligaments between the cricoid cartilage and sternal notch. The average length of trachea between the cricoid cartilage and the suprasternal notch was 6.9 to 8.2 cm. The cricothyroid muscle and cricothyroid ligament were observed and dissected and no vital anatomic structure detected. The average length and width of the cricothyroid ligament was 8 to 12 mm and 8 to 10 mm, respectively. There was a statistically significant difference between the surgical time required for cricothyrotomy and tracheostomy (p < 0.0001). Conclusion : Tracheostomy and cricothyrotomy have a low complication rate if the person performing the procedure has thorough knowledge of the neck anatomy. The choice of tracheostomy or cricothyrotomy to establish an airway depends on the patients' clinical condition, for instance; cricothyrotomy should be preferred in patients with cervicothoracal injury or dislocation who suffer from respiratory dysfunction. Furthermore; if a patient is under risk of hypoxia or anoxia due to a difficult airway, cricothyrotomy should be preferred rather than tracheostomy.

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“…The risk of significant life-threatening complications, such as severe hypoxia, regurgitation, aspiration, hypotension, bradycardia and cardiac arrest increases with each additional, unsuccessful intubation attempt [76][77][78][79].…”

Section: Recommendationmentioning

confidence: 99%