Skip to main content
SpringerLink
Log in

Incidence and factors associated with out-of-hospital peri-intubation cardiac arrest: a secondary analysis of the CURASMUR trial

  • EM - ORIGINAL
  • Published:
Internal and Emergency Medicine Aims and scope Submit manuscript

A Correction to this article was published on 12 February 2022

This article has been updated

Abstract

The Incidence of peri-intubation cardiac arrest (PICA) has been rarely assessed in the out-of-hospital setting. The objectives of this study were to assess the incidence and factors associated with PICA (cardiac arrest occurring within 15 min of intubation) in an out-of-hospital emergency setting, wherein emergency physicians perform standardized airway management using a rapid sequence intubation technique in adult patients. This was a secondary analysis of the “Succinylcholine versus Rocuronium for out-of-hospital emergency intubation” (CURASMUR) trial, which compared the first attempt intubation success rate between succinylcholine and rocuronium in adult patients requiring emergency tracheal intubation for any vital distress except cardiac arrest. Enrollment occurred from January 2014 to August 2016 in 17 French out-of-hospital emergency medical units. All operators were emergency physicians. The PICA incidence was recorded and multivariable logistic regression analysis was used to identify the factors associated with its occurrence. A total of 1226 patients were included with a mean age of 55.9 ± 19 years. PICA was recorded in 35 (2.8%) patients. Multivariable analysis indicated that the occurrence of PICA was independently associated with a body mass index (BMI) > 30 kg m2 [adjusted odds ratio (aOR) 4.85; 95% confidence interval (CI) 1.82–12.90, p = 0.02], oxygen saturation (SpO2) before intubation < 90% (aOR 3.4; 95% CI 1.50–7.60, p = 0.003), difficult intubation (defined by an Intubation Difficulty Score [IDS] > 5, [aOR 3.59; 95% CI 1.82–8.08, p = 0.02], the use of rocuronium instead of succinylcholine (aOR 2.47; 95% CI 1.08–5.64, p = 0.03), post intubation hypoxaemia (aOR 2.70; 95% CI 1.05–6.95, p = 0.04), post-intubation hypotension (aOR 4.07; 95% CI 1.62–10.22, p = 0.003), and pulmonary aspiration(aOR 4.78; 95% CI 1.48–15.36, p = 0.009). Early PICA occurred in approximately 3% of cases in the out-of-hospital setting. We identified several independent risk factors for PICA, including obesity, hypoxaemia before intubation and difficult intubation.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

Change history

References

  1. Ricard-Hibon A, Chollet C, Belpomme V, Duchateau FX, Marty J (2003) Epidemiology of adverse effects of prehospital sedation analgesia. Am J Emerg Med 21(6):461–466

    Article  Google Scholar 

  2. Timmermann A, Eich C, Russo SG et al (2006) Prehospital airway management: a prospective evaluation of anaesthesia trained emergency physicians. Resuscitation 70(2):179–185

    Article  Google Scholar 

  3. Wardi G, Villar J, Nguyen T et al (2017) Factors and outcomes associated with inpatient cardiac arrest following emergent endotracheal intubation. Resuscitation 121:76–80

    Article  Google Scholar 

  4. Pokrajac N, Sbiroli E, Hollenbach KA, Kohn MA, Contreras E, Murray M (2020) Risk factors for peri-intubation cardiac arrest in a pediatric emergency department. Pediatr Emerg Care. https://doi.org/10.1097/PEC.0000000000002171

    Article  Google Scholar 

  5. Park C (2019) Risk factors associated with inpatient cardiac arrest during emergency endotracheal intubation at general wards. Acute Crit Care 34(3):212–218

    Article  Google Scholar 

  6. Heffner AC, Swords DS, Neale MN, Jones AE (2013) Incidence and factors associated with cardiac arrest complicating emergency airway management. Resuscitation 84(11):1500–1504

    Article  Google Scholar 

  7. Mort TC (2004) The incidence and risk factors for cardiac arrest during emergency tracheal intubation: a justification for incorpaORting the ASA Guidelines in the remote location. J Clin Anesth 16(7):508–516

    Article  Google Scholar 

  8. Kim WY, Kwak MK, Ko BS et al (2014) Factors associated with the occurrence of cardiac arrest after emergency tracheal intubation in the emergency department. PLoS ONE 9(11):e112779

    Article  Google Scholar 

  9. Wang HE, Kupas DF, Hostler D, Cooney R, Yealy DM, Lave JR (2005) Procedural experience with out-of-hospital endotracheal intubation. Crit Care Med 33(8):1718–1721

    Article  Google Scholar 

  10. Adnet F, Jouriles NJ, Le Toumelin P et al (1998) Survey of out-of-hospital emergency intubations in the French prehospital medical system: a multicenter study. Ann Emerg Med 32(4):454–460

    Article  CAS  Google Scholar 

  11. Adnet F, Cydulka RK, Lapandry C (1998) Emergency tracheal intubation of patients lying supine on the ground: influence of operator body position. Can J Anaesth 45(3):266–269

    Article  CAS  Google Scholar 

  12. Buis ML, Maissan IM, Hoeks SE, Klimek M, Stolker RJ (2016) Defining the learning curve for endotracheal intubation using direct laryngoscopy: a systematic review. Resuscitation 99:63–71

    Article  Google Scholar 

  13. Guihard B, Chollet-Xemard C, Lakhnati P et al (2019) Effect of rocuronium vs succinylcholine on endotracheal intubation success rate among patients undergoing out-of-hospital rapid sequence intubation: a randomized clinical trial. JAMA 322(23):2303–2312

    Article  CAS  Google Scholar 

  14. de La Coussaye JE, Adnet F, Groupe d’experts Sfar S (2012) Sedation and analgesia in emergency structure. Which sedation and/or analgesia for tracheal intubation? Ann Fr Anesth Reanim 31(4):313–321

    Article  Google Scholar 

  15. Langeron O, Bourgain JL, Laccoureye O, Legras A, Orliaguet G (2008) Difficult airway algorithms and management: question 5. Societe Francaise d’Anesthesie et de Reanimation. Ann Fr Anesth Reanim 27(1):41–45

    Article  CAS  Google Scholar 

  16. De Jong A, Rolle A, Molinari N et al (2018) Cardiac arrest and mortality related to intubation procedure in critically ill adult patients: a multicenter cohort study. Crit Care Med 46(4):532–539

    Article  Google Scholar 

  17. Jabre P, Combes X, Lapostolle F et al (2009) Etomidate versus ketamine for rapid sequence intubation in acutely ill patients: a multicentre randomised controlled trial. Lancet 374(9686):293–300

    Article  CAS  Google Scholar 

  18. Berthoud MC, Peacock JE, Reilly CS (1991) Effectiveness of preoxygenation in morbidly obese patients. Br J Anaesth 67(4):464–466

    Article  CAS  Google Scholar 

  19. Casey JD, Rice TW, Semler MW (2019) Bag-mask ventilation during tracheal intubation of critically ill adults. Reply. N Engl J Med 380(25):2482

    PubMed  PubMed Central  Google Scholar 

  20. Holyoak RS, Melhuish TM, Vlok R, Binks M, White LD (2017) Intubation using apnoeic oxygenation to prevent desaturation: a systematic review and meta-analysis. J Crit Care 41:42–48

    Article  Google Scholar 

  21. Patanwala AE, Erstad BL, Roe DJ, Sakles JC (2016) Succinylcholine is associated with increased mortality when used for rapid sequence intubation of severely brain injured patients in the emergency department. Pharmacotherapy 36(1):57–63

    Article  CAS  Google Scholar 

Download references

Funding

The original CURASMUR study was supported by the Programme Hospitalier de Recherche Clinique 2012 of the French Ministry of Health. The Centre Hospitalier Universitaire de la Réunion is the key sponsor of this study, and by delegation the Department of Clinical Research and Development supervises all work in accordance with the French public health code.

Author information

Authors and Affiliations

  1. Department of Emergency, CHU de Bordeaux, Place Amélie Raba Léon, 33076, Bordeaux cedex, France

    Cédric Gil-Jardiné & Xavier Combes

  2. AP-HP, Service d’Aide Médicale d’Urgence (SAMU) de Paris and Paris Sudden Death Expertise Center, Université Paris Descartes, Paris, France

    Patricia Jabre

  3. Department of Anesthesia and Critical Care-SAMU, Assistance Publique-Hôpitaux de Paris, Hôpital Necker-Enfants Malades, Université Paris Descartes, 149 rue de Sèvres, 75015, Paris, France

    Patricia Jabre, Thomas Nicol & Patrick Ecollan

  4. Urgences-SAMU 93, Unite Recherche-Enseignement-Qualite, Hopital Avicenne, Bobigny, France

    Frederic Adnet

  5. Department of Emergency, CHU de la Réunion, Université de La Réunion, Réunion, France

    Bertrand Guihard

  6. INSERM CIC 1410 Clinical and Epidemiology/CHU Réunion/Université de la Réunion, Saint-Pierre, Reunion, France

    Cyril Ferdynus

  7. Departement d’Informatique Clinique, Centre Hospitalier Universitaire de La Réunion Site Félix Guyon, Saint-Denis, France

    Valery Bocquet

Authors
  1. Cédric Gil-Jardiné
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Patricia Jabre
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Frederic Adnet
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Thomas Nicol
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Patrick Ecollan
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Bertrand Guihard
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Cyril Ferdynus
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Valery Bocquet
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Xavier Combes
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Xavier Combes.

Ethics declarations

Conflict of interest

The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper entitled: “Incidence and factors associated with out-of-hospital peri-intubation cardiac arrest: A retrospective substudy of the CURASMUR Trial”.

Human and animal rights statement and Informed consent

The trial was approved by an appropriate Ethics Committee (Comité de protection des personnes Sud-ouest et outre-mer; ref 2013-001438-16) and registered under the number NCT 02000674 (clinicaltrials.gov). The need for informed consent was waived because the patients required urgent tracheal intubation. In accordance with French laws on emergency medical research, if a patient’s relative was present when the medical team had to intubate, written consent from the relative of the patient for inclusion in the clinical study was required. If no relatives were present at the time of inclusion, a letter offering the opportunity to consent or opt out of the study was sent to the patient if he or she survived and left the hospital or to a relative if the patient died in the hospital.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Gil-Jardiné, C., Jabre, P., Adnet, F. et al. Incidence and factors associated with out-of-hospital peri-intubation cardiac arrest: a secondary analysis of the CURASMUR trial. Intern Emerg Med 17, 611–617 (2022). https://doi.org/10.1007/s11739-021-02903-9

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11739-021-02903-9

Keywords

Search

Navigation