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High-risk criteria for the physiologically difficult paediatric airway: A multicenter, observational study to generate validity evidence.
Dean, Preston; Geis, Gary; Hoehn, Erin F; Lautz, Andrew J; Edmunds, Katherine; Shah, Ashish; Zhang, Yin; Frey, Mary; Boyd, Stephanie; Nagler, Joshua; Miller, Kelsey A; Neubrand, Tara L; Cabrera, Natasha; Kopp, Tara M; Wadih, Esper; Kannikeswaran, Nirupama; VanDeWall, Audrey; Hewett Brumberg, Elizabeth K; Donoghue, Aaron; Palladino, Lauren; O'Connell, Karen J; Mazzawi, Malek; Tam, Derek Chi Fung; Murray, Matthew; Kerrey, Benjamin.
Afiliación
  • Dean P; Division of Emergency Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, United States; Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, United States. Electronic address: preston.dean@cchmc.org.
  • Geis G; Division of Emergency Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, United States; Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, United States. Electronic address: gary.geis@cchmc.org.
  • Hoehn EF; Division of Emergency Medicine, UPMC Children's Hospital of Pittsburgh, University of Pittsburgh School of Medicine, Pittsburgh, PA, United States; Division of Emergency Medicine, Rainbow Babies and Children's Hospital, Case Western Reserve University School of Medicine, Cleveland, OH, United States
  • Lautz AJ; Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, United States; Division of Critical Care Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, United States. Electronic address: andrew.lautz@cchmc.org.
  • Edmunds K; Division of Emergency Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, United States; Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, United States. Electronic address: katherine.edmunds@cchmc.org.
  • Shah A; Division of Emergency Medicine, Rady Children's Hospital, University of California San Diego, San Diego, CA, United States. Electronic address: ashah@health.ucsd.edu.
  • Zhang Y; Division of Biostatistics and Epidemiology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, United States. Electronic address: yin.zhang@cchmc.org.
  • Frey M; Division of Emergency Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, United States. Electronic address: mary.frey@cchmc.org.
  • Boyd S; Division of Emergency Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, United States. Electronic address: stephanie.boyd@cchmc.org.
  • Nagler J; Boston Children's Hospital, Harvard Medical School, Boston, MA, United States. Electronic address: joshua.nagler@childrens.harvard.edu.
  • Miller KA; Boston Children's Hospital, Harvard Medical School, Boston, MA, United States. Electronic address: kelsey.miller@childrens.harvard.edu.
  • Neubrand TL; Section of Emergency Medicine, Children's Hospital Colorado, Aurora, CO, United States; Department of Emergency Medicine, University of New Mexico, Albuquerque, NM, United States. Electronic address: tneubrand@salud.unm.edu.
  • Cabrera N; Section of Emergency Medicine, Children's Hospital Colorado, Aurora, CO, United States.
  • Kopp TM; Division of Emergency Medicine, Norton Children's Hospital, University of Louisville School of Medicine, Louisville, KY, United States. Electronic address: tara.kopp.1@louisville.edu.
  • Wadih E; Division of Emergency Medicine, Norton Children's Hospital, University of Louisville School of Medicine, Louisville, KY, United States. Electronic address: esper.wadih@louisville.edu.
  • Kannikeswaran N; Division of Emergency Medicine, Children's Hospital of Michigan, Central Michigan University, Detroit, MI, United States. Electronic address: nkannike@dmc.org.
  • VanDeWall A; Division of Emergency Medicine, Children's Hospital of Michigan, Central Michigan University, Detroit, MI, United States. Electronic address: avandewa@dmc.org.
  • Hewett Brumberg EK; Division of Emergency Medicine, UPMC Children's Hospital of Pittsburgh, University of Pittsburgh School of Medicine, Pittsburgh, PA, United States. Electronic address: elizabeth.hewett@chp.edu.
  • Donoghue A; Division of Emergency Medicine, Children's Hospital of Philadelphia, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, United States. Electronic address: donoghue@chop.edu.
  • Palladino L; Division of Emergency Medicine, Children's Hospital of Philadelphia, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, United States. Electronic address: palladinol@chop.edu.
  • O'Connell KJ; Division of Emergency Medicine, Children's National Hospital, The George Washington University School of Medicine and Health Sciences, Washington, DC, United States. Electronic address: koconnel@childrensnational.org.
  • Mazzawi M; Division of Emergency Medicine, Children's National Hospital, The George Washington University School of Medicine and Health Sciences, Washington, DC, United States. Electronic address: mmazzawi2@childrensnational.org.
  • Tam DCF; Division of Emergency Medicine, Rady Children's Hospital, University of California San Diego, San Diego, CA, United States. Electronic address: dtam@health.ucsd.edu.
  • Murray M; Division of Emergency Medicine, Rady Children's Hospital, University of California San Diego, San Diego, CA, United States. Electronic address: mpmurray@health.ucsd.edu.
  • Kerrey B; Division of Emergency Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, United States; Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, United States. Electronic address: benjamin.kerrey@cchmc.org.
Resuscitation ; 190: 109875, 2023 09.
Article en En | MEDLINE | ID: mdl-37327848
BACKGROUND: Single-center studies have identified risk factors for peri-intubation cardiac arrest in the emergency department (ED). The study objective was to generate validity evidence from a more diverse, multicenter cohort of patients. METHODS: We completed a retrospective cohort study of 1200 paediatric patients who underwent tracheal intubation in eight academic paediatric EDs (150 per ED). The exposure variables were 6 previously studied high-risk criteria for peri-intubation arrest: (1) persistent hypoxemia despite supplemental oxygen, (2) persistent hypotension, (3) concern for cardiac dysfunction, (4) post-return of spontaneous circulation (ROSC), (5) severe metabolic acidosis (pH < 7.1), and (6) status asthmaticus. The primary outcome was peri-intubation cardiac arrest. Secondary outcomes included extracorporeal membrane oxygenation (ECMO) cannulation and in-hospital mortality. We compared all outcomes between patients that met one or more versus no high-risk criteria, using generalized linear mixed models. RESULTS: Of the 1,200 paediatric patients, 332 (27.7%) met at least one of 6 high-risk criteria. Of these, 29 (8.7%) suffered peri-intubation arrest compared to zero arrests in patients meeting none of the criteria. On adjusted analysis, meeting at least one high-risk criterion was associated with all 3 outcomes - peri-intubation arrest (AOR 75.7, 95% CI 9.7-592.6), ECMO (AOR 7.1, 95% CI 2.3-22.3) and mortality (AOR 3.4, 95% 1.9-6.2). Four of 6 criteria were independently associated with peri-intubation arrest: persistent hypoxemia despite supplemental oxygen, persistent hypotension, concern for cardiac dysfunction, and post-ROSC. CONCLUSIONS: In a multicenter study, we confirmed that meeting at least one high-risk criterion was associated with paediatric peri-intubation cardiac arrest and patient mortality.
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Texto completo: 1 Colección: 01-internacional Base de datos: MEDLINE Asunto principal: Paro Cardíaco / Hipotensión Tipo de estudio: Clinical_trials / Etiology_studies / Observational_studies / Prognostic_studies / Risk_factors_studies Límite: Child / Humans Idioma: En Revista: Resuscitation Año: 2023 Tipo del documento: Article Pais de publicación: Irlanda
Texto completo
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Texto completo: 1 Colección: 01-internacional Base de datos: MEDLINE Asunto principal: Paro Cardíaco / Hipotensión Tipo de estudio: Clinical_trials / Etiology_studies / Observational_studies / Prognostic_studies / Risk_factors_studies Límite: Child / Humans Idioma: En Revista: Resuscitation Año: 2023 Tipo del documento: Article Pais de publicación: Irlanda