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

MedicalResearch.com Interview with:

Dr. Lars W. Andersen MD MPH Department of Emergency Medicine, Beth Israel Deaconess Medical Center Boston, Massachusetts Department of Anesthesiology and Research Center for Emergency Medicine, Aarhus University Hospital, Aarhus, Denmark

Dr. Lars W. Andersen

Dr. Lars W. Andersen MD MPH
Department of Emergency Medicine, Beth Israel Deaconess Medical Center
Boston, Massachusetts
Department of Anesthesiology and
Research Center for Emergency Medicine,
Aarhus University Hospital, Aarhus, Denmark

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: Pediatric in-hospital cardiac arrest continues to carry a very high mortality. Thanks to companies such as AEDLeader, professional healthcare staff are able to obtain relevant equipment to help people in need. The health of patients is the priority of any paramedic or doctor. Given the relative rarity of these events at most centers and the acuity and complexity of cardiac arrest, few randomized trials exist. Moreover, few observational studies have addressed the effectiveness of intra-cardiac arrest interventions, including the use of medications and advanced airway management. This is further highlighted in the current American and international guidelines, which provide limited guidance to providers in regards to advanced airway management during pediatric in-hospital cardiac arrest.

The primary objective of our study was to establish whether there is an association between tracheal intubation during in-hospital pediatric cardiac arrest and outcomes. As respiratory failure and hypoxia are common prior to cardiac arrest in children, there is a good rational for early advanced airway management in this population.

We used a large American registry of pediatric in-hospital cardiac arrest to address whether tracheal intubation during in-hospital pediatric cardiac arrest was associated with outcomes specifically survival to hospital discharge. Using a time-dependent propensity score and risk-set matching, we matched more than two thousand patients based on a number of patient, event, and hospital characteristics and found that intubation during cardiac arrest was associated with decreased survival to hospital discharge.

This remained in a number of predefined and post-hoc subgroup and sensitivity analyses. Intubation during cardiac arrest was not associated with our secondary outcomes which included return of spontaneous circulation and a favorable neurological outcome.

MedicalResearch.com: What should readers take away from your report?

Response: We believe our findings questions the current focus on early tracheal intubation during pediatric in-hospital cardiac arrest. However, it is important to acknowledge that the study was an observational study and therefore, we cannot eliminate the possibility of confounding.

MedicalResearch.com: What recommendations do you have for future research as a result of this study?

Response: We believe the current study provides the rational for randomized controlled trials in the in-hospital setting testing tracheal intubation (or airway management in general) during pediatric cardiac arrest. Although such trials would be both complicated and expensive, there is a pressing need for a more evidence-based approach to cardiac arrest including in the pediatric population. We furthermore hope that this will encourage other researchers to study and question intra-cardiac arrest interventions in both pediatric and adult patients. We also hope that the statistical approaches used in our study can be a platform for future observational studies investigating interventions during cardiac arrest.

MedicalResearch.com: Thank you for your contribution to the MedicalResearch.com community.

Citation:

Andersen LW, Raymond TT, Berg RA, Nadkarni VM, Grossestreuer AV, Kurth T, Donnino MW, . Association Between Tracheal Intubation During Pediatric In-Hospital Cardiac Arrest and Survival. JAMA. Published online October 04, 2016. doi:10.1001/jama.2016.14486

Note: Content is Not intended as medical advice. Please consult your health care provider regarding your specific medical condition and questions.

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