Failure of Invasive Airway Placement on the First Attempt Is Associated With Progression to Cardiac Arrest in Pediatric Acute Respiratory Compromise

Objectives: The aim of this study was to describe the proportion of acute respiratory compromise events in hospitalized pediatric patients progressing to cardiopulmonary arrest, and the clinical factors associated with progression of acute respiratory compromise to cardiopulmonary arrest. We hypothesized that failure of invasive airway placement on the first attempt (defined as multiple attempts at tracheal intubation, and/or laryngeal mask airway placement, and/or the creation of a new tracheostomy or cricothyrotomy) is independently associated with progression of acute respiratory compromise to cardiopulmonary arrest. Design: Multicenter, international registry of pediatric in-hospital acute respiratory compromise. Setting: American Heart Association’s Get with the Guidelines-Resuscitation registry (2000–2014). Patients: Children younger than 18 years with an index (first) acute respiratory compromise event. Interventions: None. Measurements and Main Results: Of the 2,210 index acute respiratory compromise events, 64% required controlled ventilation, 26% had return of spontaneous ventilation, and 10% progressed to cardiopulmonary arrest. There were 762 acute respiratory compromise events (34%) that did not require an invasive airway, 1,185 acute respiratory compromise events (54%) with successful invasive airway placement on the first attempt, and 263 acute respiratory compromise events (12%) with failure of invasive airway placement on the first attempt. After adjusting for confounding variables, failure of invasive airway placement on the first attempt was independently associated with progression of acute respiratory compromise to cardiopulmonary arrest (adjusted odds ratio 1.8 [95% CIs, 1.2–2.6]). Conclusions: More than 1 in 10 hospitalized pediatric patients who experienced an acute respiratory compromise event progressed to cardiopulmonary arrest. Failure of invasive airway placement on the first attempt is independently associated with progression of acute respiratory compromise to cardiopulmonary arrest. The work was completed at The Children’s Hospital of Philadelphia, Philadelphia, PA. Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal’s website (http://ift.tt/2gIrZ5Y). Supporte d by Russell Raphaely Endowed Chair in Critical Care Medicine, The Children’s Hospital of Philadelphia. Dr. Topjian’s institution received funding from the National Institutes of Health (NIH); she received support for article research from the NIH, and she received funding from expert testimony. Dr. Sutton’s institution received funding from the NIH/National Heart, Lung, and Blood Institute; he received funding from Zoll Medical Corporation and expert testimony/case reviews, and he disclosed being a member of the Pediatric Research Task Force of the American Heart Association (AHA)’s Get with the Guidelines-Resuscitation Registry. Dr. Nadkarni is a volunteer chair of AHA’s Get with the Guidelines-Resuscitation Registry, and his institution receives unrestricted research funding from Zoll Medical and Nihon Kohden. Dr. Berg is a volunteer for the AHA’s Get with the Guidelines-Resuscitation committee and has several NIH grants funding his institution for laboratory and clinical cardiopulmonary resuscitation studies, but did not receive funding for this study. The remaining authors have disclosed that they do not have any potential conflicts of interest. For information regarding this article, E-mail: hannah.stinson@nemours.org ©2017The Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies

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