Risk Factors of Peri-Intubation Cardiac Arrest in Critically Ill Patients Presenting to the Emergency Department of a Low-Income Country: A Case-Control Study

Abstract

Background

Peri-intubation cardiac arrest incidence ranges from 0.5% to 4.2%, and the risk factors include pre-intubation hypotension, hypoxemia, metabolic acidosis, and elevated shock index. Gaps exist in understanding laboratory parameters, indications for airway protection, and the predictive value of pre-intubation modified shock index for peri‑intubation cardiac arrest.

Study Objective

This study aims to identify the risk factors associated with peri‑intubation cardiac arrest in patients presenting to the Emergency Department who require emergent airway protection.

Methods

This matched case-control study was conducted at the Emergency Department of a tertiary care hospital from January 2019 to December 2022. All adult patients requiring emergency airway management were included in the study. Cases were defined as patients who experienced cardiac arrest within 20 minutes of induction agent administration. Each case was matched with four adult controls based on age and gender (1:4 ratio). Multivariable logistic regression was performed to identify the risk factors for peri‑intubation cardiac arrest.

Results

The study included 47 cases and 188 matched controls. Multivariable regression analysis revealed that pre-intubation modified shock index of ≥ 1.3 (OR: 5.61; 95% CI: 1.9–16.5), lactic acid of ≥ 2 mmol/L (OR: 4.24; 95% CI: 1.46–12.27), arterial blood PH <7.30 (OR:2.58; 95% CI = 1.04–6.39), arterial partial pressure of oxygen <55 mmHg (OR: 5.13; 95% CI: 2.39–10.31), septic shock (OR:5.76; 95% CI: 2.93–17.18), and cardiogenic pulmonary edema (OR:5.76; 95% CI: 2.31–15.13) were predictors of peri‑intubation cardiac arrest.

Conclusion

It is imperative to implement therapeutic interventions aimed at reducing risk factors to prevent occurrences of peri‑intubation cardiac arrest.