Predictors of Per-Intubation Cardiac Arrest in Pediatrics Patients Presenting to the Emergency Department

Abstract

INTRODUCTION: Airway management is one of the vital resuscitative procedures undertaken in many critically ill pediatric patients presenting for emergency care. Around (2–33/10,000) of all pediatric patients presenting to the emergency department (ED) require airway protection for various conditions, such as respiratory failure, airway protection, and cardiac arrest 1-3. In children, airway management demands great caution because of their age-related differences in anatomical and physiological characteristics and limited physiological reserves. Rapid sequence intubation (RSI) has become the standard technique to facilitate pediatric emergency airway management. AIM OF STUDY: To determine the risk factors associated with peri-intubation cardiac arrest in pediatric patients presenting to the emergency department. RESULTS: Total 125 patients were recruited with case to control ratio of 1:4. Data was analyzed for demographic, examination, level of training, drug and outcome variables. The median age group was 18months. Among patients who underwent PICA 40% achieved the ROSC. The most common cardiacrhythm was bradycardia. The patients who underwent PICA had raised heart rate and low blood pressure. The hypoxia was found to be significant contributor to PICA. ROC curve applied to values with significant result after regression analysis. CONCLUSION: The major contributor to peri-intubation cardiac arrest is hypoxia OR 8.96 [2.52 -31.88]. Level of training had no significant relation to PICA. SI and MSI were strongly associated with PICA with OR of 3.78 [1.06 -13.52] & 4.93 [1.09 -22.24] respectively.