The following is a summary of “Prevalence of peri-intubation major adverse events among critically ill patients: A systematic review and meta analysis,” published in the September 2023 issue of Emergency Medicine by Downing, et al.

Major adverse events (MAEs) during intubation, particularly in non-operating room (OR) settings, can lead to poor patient outcomes and are often preventable. Critically ill patients requiring intubation in locations such as Emergency Departments (ED), Intensive Care Units (ICU), and medical wards are especially at risk for these events. Understanding the prevalence and risk factors associated with MAEs is crucial to help healthcare providers anticipate and prepare for challenging intubation situations.

A systematic search of PubMed, Scopus, and Embase databases was conducted to identify prospective and retrospective observational studies, as well as randomized control trials (RCTs) reporting peri-intubation MAEs outside the OR or post-anesthesia care unit (PACU). The primary outcome was defined as any peri-intubation MAE, which encompassed hypoxia, hypotension/cardiovascular collapse, or cardiac arrest. Esophageal intubation and failure to achieve first-pass success were not considered MAEs. Secondary outcomes included the prevalence of hypoxia, cardiac arrest, and cardiovascular collapse. Meta-analyses were performed to determine the prevalence of each outcome and to identify potential risk factors. The quality of the studies was assessed using the Cochrane Risk of Bias 2 tool and the Newcastle-Ottawa Scale.

The analysis included 44 articles and a total of 34,357 intubations. Peri-intubation MAEs were identified in 30.5% of the cases (95% CI 25–37%). These events were more common in the ICU (41%, 95% CI 33–49%) compared to the ED (17%, 95% CI 12–24%). Intubations performed due to hemodynamic instability were associated with higher rates of MAEs, while those conducted for airway protection had lower rates. Hypoxia occurred in 15% of intubations (95% CI 11.5–19%), cardiac arrest in 2% (95% CI 1–3.5%), and cardiovascular collapse in 18% (95% CI 13–23%).

The study revealed that nearly one in three patients undergoing intubation outside the OR and PACU experience peri-intubation MAEs. Patients intubated in the ICU and those with pre-existing hemodynamic compromise are at the highest risk. The findings emphasized the importance of considering resuscitation as an integral part of all intubations, especially for high-risk patients.

Source: sciencedirect.com/science/article/abs/pii/S0735675723003418