Background: Endotracheal intubation is associated with an increased risk of cardiorespiratory arrest. Various factors modulate the risk of peri-intubation cardiorespiratory arrest. The primary objective of this study was to determine the risk of peri-intubation cardiorespiratory arrest in pediatric patients in a hospital setting, and the secondary objective was to determine the effect of various factors on the peri-intubation cardiorespiratory arrest risk. Methods: A systematic review was performed to identify eligible manuscripts. Studies were deemed appropriate if they included pediatric patients in a hospital setting not exclusively intubated for an indication of cardiorespiratory arrest. Data was extracted from studies deemed eligible for inclusion. A pooled risk of cardiorespiratory arrest was determined. A Bayesian linear regression was conducted to model the risk of cardiorespiratory arrest. All data used in this were study-level data. Results: A total of 11 studies with 14,424 intubations were included in the final analyses. The setting for six (54.5%) studies was in the emergency department. The baseline adjusted risk for peri-intubation cardiorespiratory arrest in pediatric patients is 3.78%. The mean coefficient for a respiratory indication for intubation was -0.06, indicating that a respiratory indication for intubation reduced the peri-intubation cardiorespiratory arrest risk by 0.06%. The mean coefficient for use of ketamine was 0.07, the mean coefficient for use of a benzodiazepine was -0.14, the mean coefficient for use of a vagolytic was -0.01, and the mean coefficient for use of neuromuscular blockade was -0.40. Conclusion: Pediatric patients during the peri-intubation period have risk of developing cardiorespiratory arrest. The pooled findings demonstrate associations that seem to highlight the importance of maintaining adequate systemic oxygen delivery to limit this risk.
Loomba et al. (Thu,) studied this question.