Abstract 223: Failed Intubation Attempt During Emergency Department Resuscitation of Out-of-Hospital Cardiac Arrest Patient

Abstract

Backgrounds: Endotracheal intubation is a commonly used procedure to secure airway during emergency department (ED) resuscitation of out-of-hospital cardiac arrest (OHCA) patients. However, it can lead to many complications such as airway trauma or esophageal intubation. Currently, it is unknown whether failed intubation attempt has clinically significant impact on prognosis during resuscitation of OHCA patients in ED where multiple airway adjunct and many trained rescuers are available. Methods: An ED OHCA registry of a tertiary hospital extending from 2008 to 2012 were reviewed to identify non-traumatic OHCA patients who were resuscitated on ED arrival. Prehopsital and demographic factors and patient outcomes were retrieved from the registry. Number of failed intubation attempts was assessed from nurse-documented CPR records. Primary outcome was achievement of sustained return of spontaneous circulation (ROSC). Secondary outcomes were survival discharge and 6-month neurologic outcome. Results: 512 non-traumatic OHCA patients with ED intubation attempt during resuscitation were included. Failed intubation attempt was present in 77 patients and there was no significant difference in demographic or prehospital factors between those with and without it. With failed intubation attempt, the unadjusted and adjusted odds ratios (ORs) for achieving sustained ROSC was 0.62 (95% confidence interval [CI], 0.38-1.01) and 0.51 (95% CI, 0.29-0.89), respectively. In a propensity-matched sample, the adjusted OR was 0.82 (95% CI, 0.69-0.97). However, no significant difference in long-term outcomes was found in any of the analyses. Conclusion: Failed intubation attempt in ED was an independent risk factor for resuscitation failure in ED OHCA patients.