Brief report: incidence and outcomes of pediatric tracheal intubation-associated cardiac arrests in the ICU-RESUS clinical trial

Akira Nishisaki¹, Ron W Reeder², Elizabeth Laverriere McGovern³, Tageldin Ahmed⁴, Michael J Bell⁵, Robert Bishop⁶, Matthew Bochkoris⁷, Candice Burns⁸, Joseph A Carcillo⁷, Todd C Carpenter⁶, Wesley Diddle³, Myke Federman⁹, Ericka L Fink⁷, Deborah Franzon¹⁰, Aisha H Frazier^{11

12}, Stuart H Friess¹³, Kathryn Graham³, Mark Hall¹⁴, David A Hehir³, Christopher M Horvat⁷, Leanna L Huard⁹, Tensing Maa¹⁴, Arushi Manga¹³, Patrick McQuillen¹⁰, Kathleen L Meert⁴, Ryan W Morgan³, Peter M Mourani¹⁵, Vinay M Nadkarni³, Maryam Y Naim³, Daniel Notterman¹⁶, Chella A Palmer², Anil Sapru⁹, Carleen Schneiter⁶, Matthew P Sharron⁵, Neeraj Srivastava⁹, Shirley Viteri¹⁷, David Wessel⁵, Heather A Wolfe³, Andrew R Yates¹⁴, Athena F Zuppa³, Robert M Sutton³, Robert A Berg³

Affiliations

¹ Department of Anesthesiology and Critical Care Medicine, The Children's Hospital of Philadelphia, University of Pennsylvania, Philadelphia, PA, USA. nishisaki@chop.edu.
² Department of Pediatrics, University of Utah, Salt Lake City, UT, USA.
³ Department of Anesthesiology and Critical Care Medicine, The Children's Hospital of Philadelphia, University of Pennsylvania, Philadelphia, PA, USA.
⁴ Department of Pediatrics, Children's Hospital of Michigan, Central Michigan University, Detroit, MI, USA.
⁵ Department of Pediatrics, Children's National Hospital, George Washington University School of Medicine, Washington, DC, USA.
⁶ Department of Pediatrics, University of Colorado School of Medicine and Children's Hospital Colorado, Aurora, CO, USA.
⁷ Department of Critical Care Medicine, UPMC Children's Hospital of Pittsburgh, University of Pittsburgh, Pittsburgh, PA, USA.
⁸ Department of Pediatrics and Human Development, Michigan State University, Grand Rapids, MI, USA.
⁹ Department of Pediatrics, Mattel Children's Hospital, University of California Los Angeles, Los Angeles, CA, USA.
¹⁰ Department of Pediatrics, Benioff Children's Hospital, University of California, San Francisco, San Francisco, CA, USA.
¹¹ Nemours Cardiac Center, Nemours/Alfred I. duPont Hospital for Children, Wilmington, DE, USA.
¹² Department of Pediatrics, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA, USA.
¹³ Department of Pediatrics, Washington University School of Medicine, St. Louis, MO, USA.
¹⁴ Department of Pediatrics, Nationwide Children's Hospital, The Ohio State University, Columbus, OH, USA.
¹⁵ Department of Pediatrics, University of Arkansas for Medical Sciences and Arkansas Children's Hospital, Little Rock, AR, USA.
¹⁶ Department of Molecular Biology, Princeton University, Princeton, NJ, USA.
¹⁷ Department of Pediatrics, Nemours/Alfred I. duPont Hospital for Children and Thomas Jefferson University, Wilmington, DE, USA.

PMID: 39215367
PMCID: PMC11365269
DOI: 10.1186/s13054-024-05065-0

Randomized Controlled Trial

Brief report: incidence and outcomes of pediatric tracheal intubation-associated cardiac arrests in the ICU-RESUS clinical trial

Akira Nishisaki et al. Crit Care. 2024.

. 2024 Aug 30;28(1):286.

doi: 10.1186/s13054-024-05065-0.

Authors

Affiliations

¹ Department of Anesthesiology and Critical Care Medicine, The Children's Hospital of Philadelphia, University of Pennsylvania, Philadelphia, PA, USA. nishisaki@chop.edu.
² Department of Pediatrics, University of Utah, Salt Lake City, UT, USA.
³ Department of Anesthesiology and Critical Care Medicine, The Children's Hospital of Philadelphia, University of Pennsylvania, Philadelphia, PA, USA.
⁴ Department of Pediatrics, Children's Hospital of Michigan, Central Michigan University, Detroit, MI, USA.
⁵ Department of Pediatrics, Children's National Hospital, George Washington University School of Medicine, Washington, DC, USA.
⁶ Department of Pediatrics, University of Colorado School of Medicine and Children's Hospital Colorado, Aurora, CO, USA.
⁷ Department of Critical Care Medicine, UPMC Children's Hospital of Pittsburgh, University of Pittsburgh, Pittsburgh, PA, USA.
⁸ Department of Pediatrics and Human Development, Michigan State University, Grand Rapids, MI, USA.
⁹ Department of Pediatrics, Mattel Children's Hospital, University of California Los Angeles, Los Angeles, CA, USA.
¹⁰ Department of Pediatrics, Benioff Children's Hospital, University of California, San Francisco, San Francisco, CA, USA.
¹¹ Nemours Cardiac Center, Nemours/Alfred I. duPont Hospital for Children, Wilmington, DE, USA.
¹² Department of Pediatrics, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA, USA.
¹³ Department of Pediatrics, Washington University School of Medicine, St. Louis, MO, USA.
¹⁴ Department of Pediatrics, Nationwide Children's Hospital, The Ohio State University, Columbus, OH, USA.
¹⁵ Department of Pediatrics, University of Arkansas for Medical Sciences and Arkansas Children's Hospital, Little Rock, AR, USA.
¹⁶ Department of Molecular Biology, Princeton University, Princeton, NJ, USA.
¹⁷ Department of Pediatrics, Nemours/Alfred I. duPont Hospital for Children and Thomas Jefferson University, Wilmington, DE, USA.

PMID: 39215367
PMCID: PMC11365269
DOI: 10.1186/s13054-024-05065-0

Abstract

Background: Tracheal intubation (TI)-associated cardiac arrest (TI-CA) occurs in 1.7% of pediatric ICU TIs. Our objective was to evaluate resuscitation characteristics and outcomes between cardiac arrest patients with and without TI-CA.

Methods: Secondary analysis of cardiac arrest patients in both ICU-RESUS trial and ancillary CPR-NOVA study. The primary exposure was TI-CA, defined as cardiac arrest occurred during TI procedure or within 20 min after endotracheal tube placement. The primary outcome was survival to hospital discharge with favorable neurological outcome (Pediatric Cerebral Performance Category score 1-3 or unchanged).

Results: Among 315 children with cardiac arrests, 48 (15.2%) met criteria for TI-CA. Pre-existing medical conditions were similar between groups. Pre-arrest non-invasive mechanical ventilation was more common among TI-CA patients (18/48, 37.5%) compared to non-TI-CA patients (35/267, 13.1%). In 48% (23/48), the TI-CA occurred within 20 min after intubation (i.e., not during intubation). Duration of CPR was longer in TI-CA patients (median 11.0 min, interquartile range [IQR]: 2.5, 35.5) than non-TI-CA patients (median 5.0 min, IQR 2.0, 21.0), p = 0.03. Return of spontaneous circulation occurred in 32/48 (66.7%) TI-CA versus 186/267 (69.7%) non-TI-CA, p = 0.73. Survival to hospital discharge with favorable neurological outcome occurred in 29/48 (60.4%) TI-CA versus 146/267 (54.7%) non-TI-CA, p = 0.53.

Conclusions: Fifteen percent of these pediatric ICU cardiac arrests were associated with TI. Half of TI-CA occurred after endotracheal tube placement. While duration of CPR was longer in TI-CA patients, there were no differences in unadjusted outcomes following TI-CA versus non-TI-CA.

Trial registration: The ICU-RESUS (ClinicalTrials.gov Identifier: NCT02837497).

Keywords: Cardiac arrest; Cardiopulmonary resuscitation; Infant; Intubation; Outcome; Pediatric.

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Conflict of interest statement

The authors declare no competing interests.

References

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Brief report: incidence and outcomes of pediatric tracheal intubation-associated cardiac arrests in the ICU-RESUS clinical trial

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Brief report: incidence and outcomes of pediatric tracheal intubation-associated cardiac arrests in the ICU-RESUS clinical trial

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