Peri-Intubation Cardiorespiratory Arrest Risk in Pediatric Patients: A Systematic Review

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. 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 were 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. A total of 11 studies with 14,424 intubations were included in the final analyses. The setting for six (54.5%) studies was the emergency department. The baseline adjusted risk for peri-intubation cardiorespiratory arrest in pediatric patients was 3.78%. The mean coefficient for a respiratory indication for intubation was -0.06, indicating that a respiratory indication for intubation reduced the per-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. Pediatric patients during the peri-intubation period have the 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.