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Tracheal intubation may harm pediatric patients with in-hospital cardiac arrest
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Tracheal intubation was associated with decreased survival to hospital discharge in children and adolescents with in-hospital cardiac arrest, according to findings published in JAMA.
The researchers conducted an observational study of 2,294 pediatric patients (median age, 7 months; 57% boys) with in-hospital cardiac arrest between 2000 and 2014 in U.S. hospitals participating in the Get With the Guidelines–Resuscitation registry.
Patients were stratified by whether they had tracheal intubation, a common procedure, during cardiac arrest (68% did) and were matched via a propensity score.
The primary outcome was survival to hospital discharge. Among the secondary outcomes were return of spontaneous circulation and favorable neurologic outcome, defined as a pediatric cerebral performance category score of 1 or 2.
After propensity matching, the researchers found those with tracheal intubation had a lower rate of survival to discharge than those who did not have it (36% vs. 41%; RR = 0.89; 95% CI, 0.81-0.99).
There were no differences between the groups in return of spontaneous circulation (68% for both groups; RR = 1; 95% CI, 0.95-1.06) or favorable neurologic outcome (intubation, 19%; no intubation, 21%; RR = 0.87; 95% CI, 0.75-1.02), according to the researchers.
The survival results were consistent across most subgroup and sensitivity analyses.
“Although the study design does not eliminate the potential for confounding, these findings do not support the current emphasis on early tracheal intubation for pediatric in-hospital cardiac arrest,” Lars W. Andersen, MD, MPH, from the Research Center for Emergency Medicine, Aarhus University Hospital, Denmark, and the department of emergency medicine, Beth Israel Deaconess Medical Center, Boston, and colleagues wrote. – by Erik Swain
Disclosure: The researchers report no relevant financial disclosures.
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