Risk factors for peri-intubation cardiac arrest: a systematic review and meta-analysis

Ting-Hao Yang; Shih-Chieh Shao; Yi-Chih Lee; Chien-Han Hsiao; Chieh-Ching Yen

doi:10.1016/j.bj.2023.100656

Risk factors for peri-intubation cardiac arrest: a systematic review and meta-analysis

Biomed J. 2023 Sep 1:100656. doi: 10.1016/j.bj.2023.100656. Online ahead of print.

Authors

Ting-Hao Yang¹, Shih-Chieh Shao², Yi-Chih Lee¹, Chien-Han Hsiao³, Chieh-Ching Yen⁴

Affiliations

¹ Department of Emergency Medicine, Chang Gung Memorial Hospital, Linkou Branch, Taoyuan, Taiwan.
² Department of Pharmacy, Keelung Chang Gung Memorial Hospital, Keelung, Taiwan.
³ Department of Linguistics, Indiana University, Bloomington, IN, USA.
⁴ Department of Emergency Medicine, Chang Gung Memorial Hospital, Linkou Branch, Taoyuan, Taiwan; Department of Emergency Medicine, New Taipei Municipal Tucheng Hospital, New Taipei City, Taiwan; Department of Emergency Medicine, Jen-Ai Hospital, Dali Branch, Taichung, Taiwan. Electronic address: chiehching74@gmail.com.

PMID: 37660901
DOI: 10.1016/j.bj.2023.100656

Abstract

Background: Peri-intubation cardiac arrest (PICA) is an uncommon yet serious complication of intubation. Although some associated risk factors have been identified, the results have been inconsistent. The aim of this study was to systematically review the relevant research and examine the associated risk factors of PICA through meta-analysis.

Methods: Studies examining the risk factors for PICA before 1 Nov. 2022 were identified through searches in MEDLINE (OvidSP) and EMBASE. The reported adjusted or unadjusted odds ratios (ORs) and risk ratios (RRs) were recorded. We calculated pooled ORs and created forest plots using a random-effects model to identify the statistically significant risk factors. We assessed the certainty of evidence for each risk factor.

Results: Eight studies were included in the meta-analysis. Pre-intubation hypotension, with a pooled OR of 4.96 (95% confidence interval [C.I.]: 3.75-6.57), pre-intubation hypoxemia, with a pooled OR of 4.43 (95% C.I.: 1.24-15.81), and two or more intubation attempts, with a pooled OR of 1.88 (95% C.I.: 1.09-3.23) were associated with a significantly higher risk of PICA. The pooled incidence of PICA was 2.1% (95% C.I.: 1.5%-3.0%).

Conclusions: Pre-intubation hypotension, hypoxemia, and more intubation attempts are significant risk factors for PICA. The findings could help physicians identify patients at risk under the acute setting.

Keywords: Peri-intubation cardiac arrest; airway management; cardiac arrest; critical care; endotracheal intubation.