2015-2023年气管插管相关心脏骤停的比较分析:来自儿童国家急诊气道登记处多中心登记的报告
Comparative Analysis of Tracheal Intubation-Associated Cardiac Arrest in 2015-2023: A Report From the National Emergency Airway Registry for Children Multicenter Registry.
文献信息
| PMID | 42919448 |
|---|---|
| 原文 | 在 PubMed 查看原文 ↗ |
| 发表日期 | 2026 |
| 作者 | Asif Padiyath |
| 作者单位 | Division of Cardiothoracic Anesthesiology, Department of Anesthesiology and Critical Care Medicine, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA. |
| 期刊 | Critical care medicine |
| SCI 分区 | Q1 |
| IF | 8.1 |
| 研究类型 | 临床研究 · 临床 |
| 所属专科 | 咽喉科 |
中文摘要
目的: 确定危重儿童中气管插管相关心脏骤停(TI-CA)的当代发生率,并识别在PICU和儿童心脏ICU(PCICU)中预防TI-CA的潜在可干预因素。
设计: 回顾性队列研究。
场所: 70个国际PICU和PCICU。
患者: 在PICU和PCICU中需要气管插管的危重儿童。
干预: 使用儿童国家急诊气道登记处登记,前瞻性收集2015年1月至2023年12月期间68个PICU和PCICU中所有初始插管的气管插管数据。
测量与主要结果: TI-CA定义为气管内导管置入后20分钟内发生心脏骤停或接受胸外按压至少1分钟。正在进行的CPR期间插管不被视为TI-CA。共评估27,773次气管插管,TI-CA报告率为1.2%(n=331)。插管前氧合失败和休克与TI-CA的更高几率相关(校正比值比[aOR]分别为2.29;95% CI 1.81-2.89和aOR 4.67;95% CI 3.68-5.92)。每增加一次插管尝试与TI-CA几率增加相关(每次尝试aOR 1.70;95% CI 1.56-1.85)。使用氯胺酮(aOR 0.64;95% CI 0.49-0.82)、丙泊酚(aOR 0.44;95% CI 0.27-0.72)、神经肌肉阻滞(aOR 0.67;95% CI 0.49-0.91)和视频喉镜(aOR 0.76;95% CI 0.6-0.97)与TI-CA几率降低相关。中介分析表明,视频喉镜保护效应的13%归因于插管尝试次数的减少。氯胺酮、丙泊酚和神经肌肉阻滞的保护效应仅极小部分由插管尝试次数减少中介(分别为5%、4%和7%)。
结论: 在PICU实施的气管插管中,TI-CA发生率为1.2%。TI-CA的几率随连续插管尝试次数增加而递增。视频喉镜对TI-CA具有保护作用。中介分析显示,插管尝试次数减少解释了视频喉镜相关保护获益的13%。
英文摘要
OBJECTIVES: To determine the contemporary incidence of tracheal intubation-associated cardiac arrest (TI-CA) in critically ill children and identify potentially modifiable factors to prevent TI-CA in PICUs and pediatric cardiac ICUs (PCICUs).
DESIGN: Retrospective cohort study.
SETTING: Seventy international PICUs and PCICUs.
PATIENTS: Critically ill children requiring tracheal intubation in PICUs and PCICUs.
INTERVENTIONS: Tracheal intubation data were prospectively collected for all initial intubations in 68 PICUs and PCICUs from January 2015 to December 2023 using the National Emergency Airway Registry for Children registry.
MEASUREMENTS AND MAIN RESULTS: TI-CA was defined as CA occurrence or receipt of chest compressions for at least 1 minute within 20 minutes of endotracheal tube placement. TI during ongoing cardiopulmonary resuscitation was not considered TI-CA. A total of 27,773 TIs were evaluated, with TI-CA reported in 1.2% (n = 331). Pre-TI oxygenation failure and shock were associated with higher odds of TI-CA (adjusted odds ratio [aOR], 2.29; 95% CI, 1.81-2.89 and aOR, 4.67; 95% CI, 3.68-5.92, respectively). Each additional TI attempt required was associated with increased odds of TI-CA (aOR, 1.70; 95% CI, 1.56-1.85, for each attempt). Use of ketamine (aOR, 0.64; 95% CI, 0.49-0.82), propofol (aOR, 0.44; 95% CI, 0.27-0.72), neuromuscular blockade (aOR, 0.67; 95% CI, 0.49-0.91), and video laryngoscopy (aOR, 0.76; 95% CI, 0.6-0.97) were associated with lower odds of TI-CA. Mediation analysis indicated that 13% of video laryngoscopy's protective effect was due to a reduction in TI attempt counts. The protective effects of ketamine, propofol, and neuromuscular blockade were minimally mediated by reduced TI attempt counts (5%, 4%, and 7%).
CONCLUSIONS: TI-CA occurred in 1.2% of TIs performed in the PICUs. Odds of TI-CA increased incrementally with successive TI attempts. Video laryngoscopy was protective against TI-CA. Mediation analysis revealed that reduced TI attempts accounted for 13% of the protective benefit associated with video laryngoscopy.