Photo by A.J. Heightman / Journal of Emergency Medical Service / PennWell Corp.
Although it’s commonly practiced, results from a large new study call into question the effectiveness of intubating adults who experience in-hospital cardiac arrest.
As we report in a May news article, researchers analyzed data for 108,079 adult patients who experienced cardiac arrest in the hospital between 2000 and 2014—and found that patients who were intubated within the first 15 minutes of arresting were less likely to survive than patients who were not.
Among other findings, intubated patients were less likely to experience a return of spontaneous circulation and had a lower rate of good functional outcome (defined as either mild or no neurological deficit, or only moderate cerebral disability).
The researchers concluded that the study results do not support early intubation for adults who experience cardiac arrest. However, they noted that their analysis was unable to eliminate potential confounders like the skills and experience of health care professionals, the underlying cause of the cardiac arrest, and the quality of chest compressions. Additional clinical trials are needed to yield useful results and to better understand the influence of confounding factors.
See more news stories from our May issue, which are free to access through May 22:
- An analysis of cancer deaths at the county level pinpoints hot spots for action.
- A recent study examined the willingness of health food store staff to steer teen boys to muscle-enhancing supplements.
- Laundry detergent pods have been linked to increased eye injuries in children.
- A new clinical guideline for treating low back pain recommends trying nonpharmacologic approaches first.
There’s too little info in this article but I’d say that, in general, 15 minutes is a fairly quick timeframe from initial code to intubation. This leads me to believe that those that were intubated in that timeframe were already in a critical care setting with intubation equipment and skilled personnel readily available. This would also mean that these patients were starting out with an existing critical illness. How many of these “cardiac arrests” were vasovagal events and the patient was looking at the code team as they arrived? We’d really need to see the complete report to gain any value and this snippet probably wasn’t worth posting.
The lack of details used in this study makes me ask questions. What was the cause of cardiac arrest? Sepsis, aspiration, respiratory failure, allergic reaction? In any case, in hospital intubation and mechanical ventilation prior to an acute MI / cardiac arrest , reduces the chances of actually having an MI and arrest. Early detection and intervention will always supersede post arrest attempts to ROSC with cardiac compression only. Also non intubation increases likelihood of gastric content aspiration during CPR. Bag mask valve positive pressure ventilation during CPR will not prevent gastric inflation and aspiration pneumonia.