J Pediatr Intensive Care
DOI: 10.1055/s-0042-1758477
Review Article

Peri-Intubation Cardiorespiratory Arrest Risk in Pediatric Patients: A Systematic Review

1   Division of Pediatric Cardiac Critical Care, Advocate Children's Hospital, Oak Lawn, Illinois, United States
2   Department of Pediatrics, Chicago Medical School/Rosalind Franklin University of Medicine and Science, Chicago, Illinois, United States
,
Riddhi Patel
1   Division of Pediatric Cardiac Critical Care, Advocate Children's Hospital, Oak Lawn, Illinois, United States
,
Elizabeth Kunnel
2   Department of Pediatrics, Chicago Medical School/Rosalind Franklin University of Medicine and Science, Chicago, Illinois, United States
,
3   Tecnologico de Monterrey, Escuela de Medicina y Ciencias de la Salud, Monterrey, Nuevo Leon, Mexico
,
3   Tecnologico de Monterrey, Escuela de Medicina y Ciencias de la Salud, Monterrey, Nuevo Leon, Mexico
,
4   Section of Critical Care Medicine and Cardiology, Texas Children's Hospital, Houston, Texas, United States
5   Department of Pediatrics, Baylor College of Medicine, Houston, Texas, United States
› Author Affiliations

Abstract

Endotracheal intubation is associated with an increased risk of cardiorespiratory arrest. Various factors modulate the risk of peri-intubation cardiorespiratory arrest. The primary objective of this study was to determine the risk of peri-intubation cardiorespiratory arrest in pediatric patients in a hospital setting, and the secondary objective was to determine the effect of various factors on the peri-intubation cardiorespiratory arrest risk. A systematic review was performed to identify eligible manuscripts. Studies were deemed appropriate if they included pediatric patients in a hospital setting not exclusively intubated for an indication of cardiorespiratory arrest. Data were extracted from studies deemed eligible for inclusion. A pooled risk of cardiorespiratory arrest was determined. A Bayesian linear regression was conducted to model the risk of cardiorespiratory arrest. All data used in this were study-level data. A total of 11 studies with 14,424 intubations were included in the final analyses. The setting for six (54.5%) studies was the emergency department. The baseline adjusted risk for peri-intubation cardiorespiratory arrest in pediatric patients was 3.78%. The mean coefficient for a respiratory indication for intubation was −0.06, indicating that a respiratory indication for intubation reduced the per-intubation cardiorespiratory arrest risk by 0.06%. The mean coefficient for use of ketamine was 0.07, the mean coefficient for use of a benzodiazepine was −0.14, the mean coefficient for use of a vagolytic was −0.01, and the mean coefficient for use of neuromuscular blockade was −0.40. Pediatric patients during the peri-intubation period have the risk of developing cardiorespiratory arrest. The pooled findings demonstrate associations that seem to highlight the importance of maintaining adequate systemic oxygen delivery to limit this risk.

Data Availability

The data that support the findings of this study are available from the corresponding author upon reasonable request.




Publication History

Received: 10 May 2022

Accepted: 28 September 2022

Article published online:
06 November 2022

© 2022. Thieme. All rights reserved.

Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany

 
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