The association between timing of tracheal intubation and outcomes of adult in-hospital cardiac arrest: A retrospective cohort study

Abstract

Aim: Resuscitation guidelines indicate the ideal timing of tracheal intubation during in-hospital cardiac arrest (IHCA) has not been adequately studied.

Methods: A retrospective observational study in a single medical centre was conducted that evaluated patients with IHCA between 2006 and 2014. Multivariable logistic regression analysis was used to evaluate associations between independent variables and outcomes. Time to intubation was defined as elapsed time from the first chest compression to the time of completion of endotracheal intubation, tracheostomy, or cricothyroidotomy.

Results: A total of 702 patients were included. The mean time to intubation was 8.8min. Ninety-five (13.5%) patients survived to hospital discharge, and 44 (6.3%) patients displayed favourable neurological status at discharge. Time to intubation was shown to be inversely associated with favourable neurological outcome (odds ratio [OR]: 0.86, 95% confidence interval [CI]: 0.80-0.93; p-value <0.001). Delayed time to intubation was noted to be particularly unfavourable for survival outcome in patients with non-shockable rhythms (OR: 0.95, 95% CI: 0.91-0.98; p-value=0.005). Intubation within 8.8min of arrest was demonstrated to be positively associated with both favourable neurological outcome (OR: 7.28, 95% CI: 2.98-20.52; p-value <0.001) and survival to hospital discharge (OR: 2.09, 95% CI: 1.27-3.52; p-value=0.004).

Conclusion: Earlier tracheal intubation during cardiopulmonary resuscitation might be beneficial for clinical outcomes following IHCA. Intubation within 8.8min appears favourable for both neurological and survival outcomes. Nevertheless, this goal should be attempted by clinicians who experienced in intubation to avoid potential complications and harm.

Keywords: Airway; Cardiopulmonary resuscitation; Critical care; Heart arrest; Intubation.