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Incidence of postintubation hemodynamic instability associated with emergent intubations performed outside the operating room: a systematic review

Published online by Cambridge University Press:  04 March 2015

Robert Green ,
Brian Hutton ,
Jason Lorette ,
Dominique Bleskie ,
Lauralyn Mclntyre  and
Dean Fergusson
Robert Green*
Affiliation:
Division of Critical Care Medicine, Department of Anesthesia, and Department of Emergency Medicine, Dalhousie University, Halifax, NS Ottawa Centre for Transfusion Research, Ottawa, ON on behalf of the Canadian Critical Care Trials Group
Brian Hutton
Affiliation:
Ottawa Centre for Transfusion Research, Ottawa, ON on behalf of the Canadian Critical Care Trials Group Clinical Epidemiology Program, The Ottawa Hospital Research Institute, Ottawa, ON
Jason Lorette
Affiliation:
Division of Critical Care Medicine, Department of Anesthesia, and Department of Emergency Medicine, Dalhousie University, Halifax, NS Medical Officer/Flight Surgeon, 26 Canadian Forces Health Services Center, Greenwood, NS
Dominique Bleskie
Affiliation:
Ottawa Centre for Transfusion Research, Ottawa, ON on behalf of the Canadian Critical Care Trials Group
Lauralyn Mclntyre
Affiliation:
Ottawa Centre for Transfusion Research, Ottawa, ON on behalf of the Canadian Critical Care Trials Group Clinical Epidemiology Program, The Ottawa Hospital Research Institute, Ottawa, ON
Dean Fergusson
Affiliation:
Ottawa Centre for Transfusion Research, Ottawa, ON on behalf of the Canadian Critical Care Trials Group Clinical Epidemiology Program, The Ottawa Hospital Research Institute, Ottawa, ON
*
Department of Anesthesia, Division of Critical Care Medicine, Department of Emergency Medicine, Room 377 Bethune Building, 1276 South Park Street, Halifax, NS B3H 2Y9; [email protected]

Abstract

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Objective:

Hemodynamic instability following emergent endotracheal intubation (EETI) is a potentially life-threatening adverse event. The objectives of this systematic literature review were to document the incidence of postintubation hemodynamic instability (PIHI), to determine the definitions for PIHI used in the available literature, and to examine factors associated with PIHI in adult patients who require EETI.

Data Source:

Articles published in Medline (1966–August 2012).

Study Selection:

This systematic review included adult, inhospital studies of EETIs. Studies with nonemergent or pediatric patient populations were excluded.

Data Extraction:

Two authors independently performed data abstraction. Disagreements were resolved by a third party. The methodological quality of included studies was assessed with the Newcastle-Ottawa Quality Assessment Scale for Cohort Studies.

Data Synthesis:

We estimated the pooled prevalence of PIHI across studies using a random effects meta-analysis. Subgroups analyzed included study design, intubation setting, geographic location of the study, physician experience, medications used for sedation, neuromuscular blockade, and definition of PIHI. Eighteen studies were analyzed, with sample sizes from 84 to 2,833 patients. The incidence of PIHI ranged from 5 to 440 cases per 1,000 intubations, with a pooled estimate of 110 cases per 1,000 intubations (95% CI 65–167).

Conclusions:

PIHI was found to occur in 110 cases per 1,000 in-hospital, emergent intubations. However, heterogeneity among the included studies limits the reliability of this summary estimate. Further investigation is warranted.

Keywords

emergencyhypotensionmeta-analysisrapid sequence intubationsystematic review
Type
State of the Art • À la fine pointe
Information
Canadian Journal of Emergency Medicine , Volume 16 , Issue 1 , January 2014 , pp. 69 - 79
Copyright
Copyright © Canadian Association of Emergency Physicians 2014

References

REFERENCES

1.Griesdale, DE, Henderson, WR, Green, RS.Airway management in critically ill patients. Lung 2011;189:181–92, doi:10.1007/s00408-011-9278-3.CrossRefGoogle ScholarPubMed
2.Walz, JM, Zayaruzny, M, Heard, SO.Airway management in critical illness. Chest 2007;131:608–20, doi:10.1378/chest.06-2120.CrossRefGoogle ScholarPubMed
3.Dorges, V.Airway management in emergency situations. Best Pract Res Clin Anaesthesiol 2005;19:699–715, doi:10.1016/j.bpa.2005.07.003.CrossRefGoogle ScholarPubMed
4.Shuster, M, Lim, SH, Deakin, CD, et al. CPR Techniques and Devices Collaborators. Part 7: CPR techniques and devices: 2010 international consensus on cardiopulmonary resuscitation and emergency cardiovascular care science with treatment recommendations. Circulation 2010;122(16 Suppl 2):S338–44, doi:10.1161/CIRCULATIONAHA.110.971036.Google Scholar
5.Hazinski, MF, Nolan, JP, Billi, JE. Part 1: Executive summary: 2010 international consensus on cardiopulmonary resuscitation and emergency cardiovascular care science with treatment recommendations. Circulation 2010;122(16 Suppl 2):S250–75, doi:10.1161/CIRCULATIONAHA.110.970897.CrossRefGoogle ScholarPubMed
6.Fasting, S, Gisvold, SE.Serious intraoperative problems—a five-year review of 83,844 anesthetics. Can J Anaesth 2002;49:545–53, doi:10.1007/BF03017379.Google Scholar
7.Domino, KB, Posner, KL, Caplan, RA, et al. Airway injury during anesthesia: a closed claims analysis. Anesthesiology 1999;91:1703–11, doi:10.1097/00000542-199912000-00023.CrossRefGoogle ScholarPubMed
8.Griesdale, DE, Bosma, TL, Kurth, T, et al. Complications of endotracheal intubation in the critically ill. Intensive Care Med 2008;34:1835–42, doi:10.1007/s00134-008-1205-6.CrossRefGoogle ScholarPubMed
9.Jaber, S, Amraoui, J, Lefrant, JY, et al. Clinical practice and risk factors for immediate complications of endotracheal intubation in the intensive care unit: a prospective, multiplecenter study. Crit Care Med 2006;34:2355–61, doi:10.1097/01.CCM.0000233879.58720.87.CrossRefGoogle ScholarPubMed
10.Jaber, S, Jung, B, Corne, P, et al. An intervention to decrease complications related to endotracheal intubation in the intensive care unit: a prospective, multiple-center study. Intensive Care Med 2010;36:248–55, doi:10.1007/s00134-009-1717-8.CrossRefGoogle ScholarPubMed
11.Mort, TC.Complications of emergency tracheal intubation: hemodynamic alterations—part I. J Intensive Care Med 2007; 22:157–65, doi:10.1177/0885066607299525.Google Scholar
12.Mort, TC.Complications of emergency tracheal intubation: immediate airway-related consequences: part II. J Intensive Care Med 2007;22:208–15, doi:10.1177/0885066607301359.CrossRefGoogle ScholarPubMed
13.Hagberg, C, Georgi, R, Krier, C.Complications of managing the airway. Best Pract Res Clin Anaesthesiol 2005;19:641–59, doi:10.1016/j.bpa.2005.08.002.CrossRefGoogle ScholarPubMed
14.Sivilotti, ML.You need tube, me give one amp of etomidate and SUX. CJEM 2006;8:351–3.CrossRefGoogle ScholarPubMed
15.Green, R.Etomidate and RSI: how important is postintubation hypotension? CJEM 2007;9:3; author reply 3–4.CrossRefGoogle Scholar
16.Green, RS, Edwards, J, Sabri, E, et al. Evaluation of the incidence, risk factors, and impact on patient outcomes of postintubation hemodynamic instability. CJEM 2012;14:74–82.CrossRefGoogle ScholarPubMed
17.Heffner, AC, Swords, DS, Nussbaum, ML, et al. Predictors of the complication of postintubation hypotension during emergency airway management. J Crit Care 2012;27:587–93, doi:10.1016/j.jcrc.2012.04.022.CrossRefGoogle ScholarPubMed
18.Jabre, P, Combes, X, Lapostolle, F, et al. KETASED Collaborative Study Group. Etomidate versus ketamine for rapid sequence intubation in acutely ill patients: a multicentre randomised controlled trial. Lancet 2009;374:293–300, doi:10.1016/S0140-6736(09)60949-1.Google Scholar
19.Zed, PJ, Abu-Laban, RB, Harrison, DW.Intubating conditions and hemodynamic effects of etomidate for rapid sequence intubation in the emergency department: an observational cohort study. Acad Emerg Med 2006;13:378–83, doi:10.1111/j.1553-2712.2006.tb00313.x.CrossRefGoogle ScholarPubMed
20.Sivilotti, ML, Randomized, Ducharme J.double-blind study on sedatives and hemodynamics during rapid-sequence intubation in the emergency department: the SHRED study. Ann Emerg Med 1998;31:313–24, doi:10.1016/S0196-0644(98)70341-5.CrossRefGoogle ScholarPubMed
21.Reid, C, Chan, L, Tweeddale, M.The who, where, and what of rapid sequence intubation: prospective observational study of emergency RSI outside the operating theatre. Emerg Med J 2004;21:296–301, doi:10.1136/emj.2003.007344.CrossRefGoogle ScholarPubMed
22.Mort, TC.Emergency tracheal intubation: complications associated with repeated laryngoscopic attempts. AnesthAnalg 2004;99:607–13, doi:10.1213/01.ANE.0000122825.04923.15.Google Scholar
23.Choi, YF, Wong, TW, Lau, CC.Midazolam is more likely to cause hypotension than etomidate in emergency department rapid sequence intubation. Emerg Med J 2004;21:700–2, doi:10.1136/emj.2002.004143.CrossRefGoogle ScholarPubMed
24.Wong, E, Fong, YT, Ho, KK.Emergency airway management—experience of a tertiary hospital in south-east Asia. Resuscitation 2004;61:349–55, doi:10.1016/j.resuscitation.2004.01.011.CrossRefGoogle ScholarPubMed
25.Wong, E, Fong, YT.Trauma airway experience by emergency physicians. Eur J Emerg Med 2003;10:209–12, doi:10.1097/00063110-200309000-00010.CrossRefGoogle ScholarPubMed
26.Graham, CA, Beard, D, Oglesby, AJ, et al. Rapid sequence intubation in Scottish urban emergency departments. Emerg Med J 2003;20:3–5, doi:10.1136/emj.20.1.3.CrossRefGoogle ScholarPubMed
27.Marvez, E, Weiss, SJ, Houry, DE, et al. Predicting adverse outcomes in a diagnosis-based protocol system for rapid sequence intubation. Am J Emerg Med 2003;21:23–9, doi:10.1053/ajem.2003.50002.CrossRefGoogle Scholar
28.Tam, AY, Lau, FL.A prospective study of tracheal intubation in an emergency department in Hong Kong. Eur J Emerg Med 2001;8:305–10, doi:10.1097/00063110-200112000-00011.Google Scholar
29.Tayal, VS, Riggs, RW, Marx, JA, et al. Rapid-sequence intubation at an emergency medicine residency: success rate and adverse events during a two-year period. Acad Emerg Med 1999;6:31–7, doi:10.1111/j.1553-2712.1999.tb00091.x.CrossRefGoogle ScholarPubMed
30.Sakles, JC, Laurin, EG, Rantapaa, AA, et al. Airway management in the emergency department: a one-year study of 610 tracheal intubations. Ann Emerg Med 1998;31:325–32, doi:10.1016/S0196-0644(98)70342-7.Google Scholar
31.Franklin, C, Samuel, J, Hu, TC.Life-threatening hypotension associated with emergency intubation and the initiation of mechanical ventilation. Am J Emerg Med 1994;12:425–8, doi:10.1016/0735-6757(94)90053-1.Google Scholar
32.Lin, CC, Chen, KF, Shih, CP, et al. The prognostic factors of hypotension after rapid sequence intubation. Am J Emerg Med 2008;26:845–51, doi:10.1016/j.ajem.2007.11.027.Google Scholar
33.Dufour, DG, Larose, DL, Clement, SC.Rapid sequence intubation in the emergency department. J Emerg Med 1995; 13:705–10, doi:10.1016/0736-4679(95)00089-S.Google Scholar
34.Jones, AE, Yiannibas, V, Johnson, C, et al. Emergency department hypotension predicts sudden unexpected inhospital mortality: a prospective cohort study. Chest 2006;130:941–6, doi:10.1378/chest.130.4.941.Google Scholar
35.Kelly-Smith, C, Hohl, C.Should emergency physicians use etomidate for rapid sequence intubation? CJEM 2011;13:44–7.Google Scholar
36.el-Beheiry, H, Kim, J, Milne, B, et al. Prophylaxis against the systemic hypotension induced by propofol during rapidsequence intubation. Can J Anaesth 1995;42:875–8, doi:10.1007/BF03011034.Google Scholar
37.Kasaba, T, Yamaga, M, Iwasaki, T, et al. Ephedrine, dopamine, or dobutamine to treat hypotension with propofol during epidural anesthesia. Can J Anaesth 2000;47:237–41, doi:10.1007/BF03018919.CrossRefGoogle ScholarPubMed