Abstract
To investigate whether the optimal time to tracheal intubation (TTI) during cardiopulmonary resuscitation would differ by different blood gas phenotypes. Adult patients experiencing in-hospital cardiac arrest (IHCA) from 2006 to 2015 were retrospectively screened. Early intra-arrest blood gas analysis, performed within 10 min of resuscitation, was used to define different phenotypes. In total, 567 patients were included. Non-severe acidosis (pH≧7.15) was associated with favourable neurological outcome (odds ratio [OR]: 4.60, 95% confidence interval [CI] 1.63–12.95; p value = 0.004) and survival (OR: 3.25, 95% CI 1.72–6.15; p value < 0.001) in the multivariable logistic regression analyses. In the interaction analysis, normal blood gas phenotype (pH: 7.35–7.45, PCO2: 35–45 mm Hg, HCO3− level: 22–26 mmol/L) × TTI ≦ 6.3 min (OR: 20.40, 95% CI 2.53–164.75; p value = 0.005) and non-severe acidosis × TTI ≦ 6.3 min (OR: 3.35, 95% CI 1.00–11.23; p value = 0.05) were associated with neurological recovery while metabolic acidosis × TTI ≦ 5.7 min (OR: 3.63, 95% CI 1.36–9.67; p value = 0.01) and hypercapnic acidosis × TTI ≦ 10.4 min (OR: 2.27, 95% CI 1.20–4.28; p value = 0.01) were associated with survival. Intra-arrest blood gas analysis may help guide TTI during for patients with IHCA.
Highlights
209,000 patients experience in-hospital cardiac arrest (IHCA) in the United States a nnually[1]
We first attempted to investigate whether intra-arrest blood gas analysis could help classify IHCA patients into distinct phenotypes with different prognoses; second, we attempted to investigate whether the optimal timing of tracheal intubation would differ according to different phenotypes
For IHCA occurring in the intensive care units (ICUs), cardiopulmonary resuscitation (CPR) is performed by the ICU staff without activating a code team
Summary
209,000 patients experience in-hospital cardiac arrest (IHCA) in the United States a nnually[1]. Point-of-care blood testing may yield important diagnostic information and guide therapeutic management during cardiopulmonary resuscitation (CPR). Substantial heterogeneity exists between patients even if they are classified within the same category In scenarios such as prehospital CPR, this crude classification system may be necessary; for IHCA resuscitation, a more elaborate categorization may facilitate the application of appropriate therapeutics. S tudies[4,5] indicated that tracheal intubation during CPR may cause harm for patients without respiratory failure prior to IHCA but may not do so for patients with prior respiratory failure. We first attempted to investigate whether intra-arrest blood gas analysis could help classify IHCA patients into distinct phenotypes with different prognoses; second, we attempted to investigate whether the optimal timing of tracheal intubation would differ according to different phenotypes. Besides traditionally defined blood gas phenotypes, we would attempt to identify new phenotypes which may influence the optimal timing of tracheal intubation
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