Abstract
Aim
Tracheal intubation is associated with interruption in cardiopulmonary resuscitation
(CPR). Current knowledge of tracheal intubation during active CPR focuses on the out-of-hospital
environment. We aim to describe characteristics of tracheal intubation during active
CPR in the emergency department (ED) and determine whether first attempt success was
associated with CPR being continued vs paused.
Measurements
We reviewed overhead video from adult ED patients receiving chest compressions at
the start of the orotracheal intubation attempt. We recorded procedural detail including
method of CPR, whether CPR was continued vs paused, and first attempt intubation success
(primary outcome). We performed logistic regression to determine whether continuing
CPR was associated with first attempt success.
Results
We reviewed 169 instances of tracheal intubation, including 143 patients with continued
CPR and 26 patients with paused CPR. Those with paused CPR were more likely to be
receiving manual rather than mechanical chest compressions. Video laryngoscopy and
bougie use were common. First attempt success was higher in the continued CPR group
(87%, 95% CI 81% to 92%) than the interrupted CPR group (65%, 95% CI 44% to 83%, difference
22% [95% CI 3% to 41%]). The multivariable model demonstrated an adjusted odds ratio
of 0.67 (95% CI 0.17 to 2.60) for first attempt intubation success when CPR was interrupted
vs continued.
Conclusions
It was common to continue CPR during tracheal intubation, with success comparable
to that achieved in patients without cardiac arrest. It is reasonable to attempt tracheal
intubation without interrupting CPR, pausing only if necessary.
Keywords
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Article info
Publication history
Published online: February 08, 2023
Accepted:
February 2,
2023
Received in revised form:
January 31,
2023
Received:
November 22,
2022
Publication stage
In Press Journal Pre-ProofIdentification
Copyright
© 2023 Elsevier B.V. All rights reserved.
