The following is a summary of “Peri-Intubation Arrest: High vs. Standard Risk in Pediatric Trauma Patients,” published in the May 2023 issue of Emergency Medicine by VanDeWall et al.
Although the anatomically tricky airway in pediatric trauma patients has been studied, physiologic risk factors remain inadequately understood. Our goal was to determine whether previously published high-risk physiologic criteria for difficult airways in medical patients are associated with adverse outcomes in pediatric trauma patients. This was a retrospective chart review of pediatric emergency department (PED) patients ≤18 years old with traumatic injuries who underwent endotracheal intubation (EI) between 2016 and 2021. Hypotension, concern for cardiac dysfunction, persistent hypoxemia, severe metabolic acidosis (pH< 7.1), and post–return of spontaneous circulation were evaluated as high-risk criteria.
Our primary outcome was cardiac arrest within 10 minutes of endotracheal intubation (EI). Secondary outcomes included in-hospital cardiac arrest and mortality and EI success on the first attempt. One-third (n = 32; 36.4%) of the 88 examined patients met at least one high-risk criterion. Those in the high-risk group had a higher incidence of peri-intubation arrest (28.1% vs. 0%, difference: 28.1%, 95% CI: 10.2–46.2), PED/in-hospital arrest (43.8% vs. 3.4%, difference: 38.4%, 95% CI: 17.8–59.0), and in-hospital mortality (33.4% vs. 3.6%, difference: 29.8%, 95% CI: 8.4-46.9.
Multiple high-risk criteria incrementally increased the likelihood of post-intubation PED/in-hospital cardiac arrest (1 risk factor: OR = 6.7, 95% CI: 1.5–30.2; 2 risk factors: OR = 12.5, 95% CI: 2.3–70.0; 3 risk factors: OR = 56.1, 95% CI: 6.0–523.8). In pediatric trauma patients, the prevalence of high-risk physiologic criteria is associated with increased peri-intubation, in-hospital arrest, and death. Multiple risk factors increase the risk of cardiac arrest in children.