دورية أكاديمية
High-risk criteria for the physiologically difficult paediatric airway: A multicenter, observational study to generate validity evidence
| العنوان: | High-risk criteria for the physiologically difficult paediatric airway: A multicenter, observational study to generate validity evidence |
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| المؤلفون: | 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, Murray, Matthew, Kerrey, Benjamin |
| المصدر: | GW Authored Works |
| بيانات النشر: | Health Sciences Research Commons |
| سنة النشر: | 2023 |
| المجموعة: | George Washington University: Health Sciences Research Commons (HSRC) |
| مصطلحات موضوعية: | ECMO, Emergency Department, Paediatrics, Peri-intubation cardiac arrest, Tracheal intubation |
| الوصف: | 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. |
| نوع الوثيقة: | text |
| اللغة: | unknown |
| العلاقة: | https://hsrc.himmelfarb.gwu.edu/gwhpubs/2718Test; https://doi.org/10.1016/j.resuscitation.2023.109875Test |
| DOI: | 10.1016/j.resuscitation.2023.109875 |
| الإتاحة: | https://doi.org/10.1016/j.resuscitation.2023.109875Test https://hsrc.himmelfarb.gwu.edu/gwhpubs/2718Test |
| رقم الانضمام: | edsbas.A4B4EC1E |
| قاعدة البيانات: | BASE |
| DOI: | 10.1016/j.resuscitation.2023.109875 |
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