Blood gas phenotyping and tracheal intubation timing in adult in-hospital cardiac arrest: a retrospective cohort study

To investigate whether the optimal time to tracheal intubation (TTI) during cardiopulmonary resuscitation would differ by different blood gas phenotypes. Adult patients experiencing in-hospital cardiac arrest (IHCA) from 2006 to 2015 were retrospectively screened. Early intra-arrest blood gas analysis, performed within 10 min of resuscitation, was used to define different phenotypes. In total, 567 patients were included. Non-severe acidosis (pH7.15) was associated with favourable neurological outcome (odds ratio [OR]: 4.60, 95% confidence interval [CI] 1.63-12.95; p value=0.004) and survival (OR: 3.25, 95% CI 1.72-6.15; p value<0.001) in the multivariable logistic regression analyses. In the interaction analysis, normal blood gas phenotype (pH: 7.35-7.45, PCO2: 35-45 mm Hg, HCO3- level: 22-26 mmol/L)xTTI 6.3 min (OR: 20.40, 95% CI 2.53-164.75; p value=0.005) and non-severe acidosisxTTI 6.3 min (OR: 3.35, 95% CI 1.00-11.23; p value=0.05) were associated with neurological recovery while metabolic acidosisxTTI 5.7 min (OR: 3.63, 95% CI 1.36-9.67; p value=0.01) and hypercapnic acidosisxTTI 10.4 min (OR: 2.27, 95% CI 1.20-4.28; p value=0.01) were associated with survival. Intra-arrest blood gas analysis may help guide TTI during for patients with IHCA.