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Cardiac Arrest and Mortality Related to Intubation Procedure in Critically Ill Adult Patients

A Multicenter Cohort Study

De Jong, Audrey, MD, PhD1,2; Rolle, Amélie, MD1,3; Molinari, Nicolas, PhD4; Paugam-Burtz, Catherine, MD, PhD5,6; Constantin, Jean-Michel, MD, PhD7; Lefrant, Jean-Yves, MD, PhD8; Asehnoune, Karim, MD, PhD9; Jung, Boris, MD, PhD2,10; Futier, Emmanuel, MD, PhD7; Chanques, Gérald, MD, PhD1,2; Azoulay, Elie, MD, PhD11; Jaber, Samir, MD, PhD1,2

doi: 10.1097/CCM.0000000000002925
Clinical Investigations

Objectives: To determine the prevalence of and risk factors for cardiac arrest during intubation in ICU, as well as the association of ICU intubation–related cardiac arrest with 28-day mortality.

Design: Retrospective analysis of prospectively collected data.

Setting: Sixty-four French ICUs.

Patients: Critically ill patients requiring intubation in the ICU.

Interventions: None.

Measurements and Main Results: During the 1,847 intubation procedures included, 49 cardiac arrests (2.7%) occurred, including 14 without return of spontaneous circulation (28.6%) and 35 with return of spontaneous circulation (71.4%). In multivariate analysis, the main predictors of intubation-related cardiac arrest were arterial hypotension (systolic blood pressure < 90 mm Hg) prior to intubation (odds ratio = 3.406 [1.797–6.454]; p = 0.0002), hypoxemia prior to intubation (odds ratio = 3.991 [2.101–7.583]; p < 0.0001), absence of preoxygenation (odds ratio = 3.584 [1.287–9.985]; p = 0.0146), overweight/obesity (body mass index > 25 kg/m2; odds ratio = 2.005 [1.017–3.951]; p = 0.0445), and age more than 75 years old (odds ratio = 2.251 [1.080–4.678]; p = 0.0297). Overall 28-day mortality rate was 31.2% (577/1,847) and was significantly higher in patients who experienced intubation-related cardiac arrest than in noncardiac arrest patients (73.5% vs 30.1%; p < 0.001). After multivariate analysis, intubation-related cardiac arrest was an independent risk factor for 28-day mortality (hazard ratio = 3.9 [2.4–6.3]; p < 0.0001).

Conclusions: ICU intubation–related cardiac arrest occurs in one of 40 procedures with high immediate and 28-day mortality. We identified five independent risk factors for cardiac arrest, three of which are modifiable, possibly to decrease intubation-related cardiac arrest prevalence and 28-day ICU mortality.

1Anesthesiology and Intensive Care, Anesthesia and Critical Care Department B, Saint Eloi Teaching Hospital, Unité INSERM U1046, Université Montpellier 1, Université Montpellier 2, Centre Hospitalier Universitaire Montpellier, Montpellier, France.

2INSERM U1046, CNRS UMR 9214, Montpellier, France.

3Department of Intensive Care & Anesthesiology, University of Pointe à Pitre Hospital. Guadeloupe, France.

4Department of Statistics, University of Montpellier Lapeyronie Hospital, UMR 5149 IMAG, Montpellier, France.

5Department of Intensive Care & Anesthesiology, University of Paris Diderot, Sorbonne Paris Cité, Paris, France.

6AP-HP, Hôpital Beaujon, Paris, France.

7Department of Intensive Care & Anesthesiology, Hotel-Dieu Hospital, University Hospital of Clermont Ferrand, Clermont-Ferrand, France.

8Department of Intensive Care & Anesthesiology, University of Montpellier, Nimes Hospital, Nimes, France.

9Department of Intensive Care & Anesthesiology, University of Nantes, Hotel-Dieu Hospital, Nantes, France.

10Medical Intensive Care Unit, Lapeyronie Teaching Hospital, Centre Hospitalier Universitaire Montpellier, Montpellier, France.

11Medical Intensive Care Unit, University of Paris-Diderot, Saint Louis Hospital, Paris, France.

This study was performed at University of Montpellier, Montpellier University Hospital.

Drs. De Jong and Rolle contributed equally to this study. Drs. De Jong, Rolle, and Jaber contributed to study concept and design. Drs. De Jong, Rolle, and Chanques contributed in acquisition of the data. Drs. De Jong, Chanques, Azoulay, and Jaber contributed to data analysis and interpretation. Drs. De Jong, Rolle, Paugam-Burtz, Constantin, Lefrant, Asehnoune, Jung, Futier, Chanques, and Jaber contributed in article preparation and drafting. Drs. De Jong and Molinari contributed to statistical methods, statistical data analysis. Drs. Lefrant, Asehnoune, Jung, and Azoulay contributed in article critique and review. All authors approved the article submitted.

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Supported, in part, by institutional and/or departmental sources (Institutional University Hospital of Montpellier, 34000, France).

Dr. Asehnoune declares interest conflicts with LFB, Fresenius Kabi, Baxter companies. Dr. Futier declares interest conflicts with General Electric Medical Systems and Fresenius Kabi companies. Dr. Jaber declares interest conflicts with Dräger, Hamilton, Maquet and Fisher Paykel Healthcare companies.

Dr. Asehnoune received funding for lectures from MSD, Fresenius Kabi, Baxter, and LFB. Dr. Futier received funding from Drager Medical, Edwards Lifesciences, Fresenius Kabi, General Electrics Healthcare, and Fisher & Paykel Healthcare. Dr. Azoulay’s institution received funding from Fisher & Paykel, Gilead, Jazz Pharma, and Alexion. He received funding from lectures for Gilead, MSD, Alexion, Astellas, Baxter, and as a member of the board for Gilead. He also received support for article research from APHP. The remaining authors have disclosed that they do not have any potential conflicts of interest.

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