Association Between Tracheal Intubation During Adult In-Hospital Cardiac Arrest and Survival.

ABSTRACT: Importance:Tracheal intubation is common during adult in-hospital cardiac arrest, but little is known about the association between tracheal intubation and survival in this setting. Objective:To determine whether tracheal intubation during adult in-hospital cardiac arrest is associated with survival to hospital discharge. Design, Setting, and Participants:Observational cohort study of adult patients who had an in-hospital cardiac arrest from January 2000 through December 2014 included in the Get With The Guidelines-Resuscitation registry, a US-based multicenter registry of in-hospital cardiac arrest. Patients who had an invasive airway in place at the time of cardiac arrest were excluded. Patients intubated at any given minute (from 0-15 minutes) were matched with patients at risk of being intubated within the same minute (ie, still receiving resuscitation) based on a time-dependent propensity score calculated from multiple patient, event, and hospital characteristics. Exposure:Tracheal intubation during cardiac arrest. Main Outcomes and Measures:The primary outcome was survival to hospital discharge. Secondary outcomes included return of spontaneous circulation (ROSC) and a good functional outcome. A cerebral performance category score of 1 (mild or no neurological deficit) or 2 (moderate cerebral disability) was considered a good functional outcome. Results:The propensity-matched cohort was selected from 108?079 adult patients at 668 hospitals. The median age was 69 years (interquartile range, 58-79 years), 45?073 patients (42%) were female, and 24?256 patients (22.4%) survived to hospital discharge. Of 71?615 patients (66.3%) who were intubated within the first 15 minutes, 43?314 (60.5%) were matched to a patient not intubated in the same minute. Survival was lower among patients who were intubated compared with those not intubated: 7052 of 43?314 (16.3%) vs 8407 of 43?314 (19.4%), respectively (risk ratio [RR]?=?0.84; 95% CI, 0.81-0.87; P?

SUBMITTER: Andersen LW 

PROVIDER: S-EPMC6056890 | biostudies-literature | 2017 Feb

REPOSITORIES: biostudies-literature