Researchers from multiple institutions conducted a retrospective observational study of data from US hospitals that belonged to the American Heart Association’s Get With the Guidelines—Resuscitation (GWTG-R) registry to assess the association of tracheal intubation during pediatric in-hospital cardiac arrests and survival to hospital discharge. All patients <18 years hospitalized at a registry hospital during 2000–2014 who had an index cardiac arrest with ≥1 minute of chest compressions were included. Patients were excluded if they were receiving assisted ventilation or had an invasive airway in place at the time chest compressions were initiated.
The primary exposure was tracheal intubation during the cardiac arrest event. The time of intubation was defined as the time interval in minutes from the start of chest compressions until the tracheal tube was inserted. The primary outcome was survival to hospital discharge. Secondary outcomes were return of spontaneous circulation (ROSC), defined as no further need for chest compressions that was sustained for >20 minutes, and favorable neurologic outcome at hospital discharge, according to pediatric cerebral performance category scores. Time-dependent propensity-matched multivariable analysis was used to assess the adjusted association between tracheal intubation during CPR and survival to hospital discharge in order to account for the time of intubation, since intubation can be a function of prolonged resuscitation and prolonged resuscitation is associated with poor outcomes.
There were 2,294 participants included in analysis, with 57% being male and the median age being 7 months. Overall, 68% (1,555) were intubated during cardiac arrest and 51% (1,162) survived to hospital discharge. ROSC was achieved in 77% (1,766), and 30% had a favorable neurologic outcome.
In propensity-matched multivariable analyses, participants intubated during cardiac arrest had lower rates of survival compared with those who were not intubated (36% vs 41%; P=.03). There was no significant difference in ROSC or favorable neurologic outcome between intubated and nonintubated patients.
The researchers conclude that tracheal intubation during pediatric in-hospital cardiac arrest is associated with decreased survival to hospital discharge.
Dr. Bratton has disclosed no financial relationship relevant to this commentary. This commentary does not contain a discussion of an unapproved/investigative use of a commercial product/device.
Because invasive interventions are more likely to be used in the most severely ill neonates and children, they are often associated with poor outcomes.1 The current investigators used observational data from the GWTG-R to “adjust” for severity of illness and assess the likelihood of ROSC after cardiac arrest and survival. Because shorter duration of CPR is associated with improved survival, the authors performed an analysis that used minutes of CPR until ROSC as a time-dependent covariate in a proportional hazards model. The authors used propensity matching of patients who were intubated during CPR to patients who were not but had...