Association Between Tracheal Intubation During Adult In-Hospital Cardiac Arrest and Survival

• Published in: JAMA : the journal of the American Medical Association 2017-02, Vol.317 (5), p.494-506
• Main Authors: Andersen, Lars W, Granfeldt, Asger, Callaway, Clifton W, Bradley, Steven M, Soar, Jasmeet, Nolan, Jerry P, Kurth, Tobias, Donnino, Michael W
• Format: Article
• Language: English
• Subjects: Adults; Aged; Aged, 80 and over; Blood Circulation; Case-Control Studies; Cohort Studies; Continental Population Groups; Female; Heart Arrest - mortality; Heart Arrest - physiopathology; Heart Arrest - therapy; Heart attacks; Hospitalization; Humans; Intubation; Intubation, Intratracheal - mortality; Intubation, Intratracheal - statistics & numerical data; Male; Middle Aged; Outcome Assessment (Health Care); Patient Discharge; Propensity Score; Recovery of Function; Registries; Retrospective Studies; Survival Analysis; Time Factors; United States
• ISSN: 0098-7484; 1538-3598
• DOI: 10.1001/jama.2016.20165

IMPORTANCE: Tracheal intubation is common during adult in-hospital cardiac arrest, but little is known about the association between tracheal intubation and survival in this setting. OBJECTIVE: To determine whether tracheal intubation during adult in-hospital cardiac arrest is associated with survival to hospital discharge. DESIGN, SETTING, AND PARTICIPANTS: Observational cohort study of adult patients who had an in-hospital cardiac arrest from January 2000 through December 2014 included in the Get With The Guidelines–Resuscitation registry, a US-based multicenter registry of in-hospital cardiac arrest. Patients who had an invasive airway in place at the time of cardiac arrest were excluded. Patients intubated at any given minute (from 0-15 minutes) were matched with patients at risk of being intubated within the same minute (ie, still receiving resuscitation) based on a time-dependent propensity score calculated from multiple patient, event, and hospital characteristics. EXPOSURE: Tracheal intubation during cardiac arrest. MAIN OUTCOMES AND MEASURES: The primary outcome was survival to hospital discharge. Secondary outcomes included return of spontaneous circulation (ROSC) and a good functional outcome. A cerebral performance category score of 1 (mild or no neurological deficit) or 2 (moderate cerebral disability) was considered a good functional outcome. RESULTS: The propensity-matched cohort was selected from 108 079 adult patients at 668 hospitals. The median age was 69 years (interquartile range, 58-79 years), 45 073 patients (42%) were female, and 24 256 patients (22.4%) survived to hospital discharge. Of 71 615 patients (66.3%) who were intubated within the first 15 minutes, 43 314 (60.5%) were matched to a patient not intubated in the same minute. Survival was lower among patients who were intubated compared with those not intubated: 7052 of 43 314 (16.3%) vs 8407 of 43 314 (19.4%), respectively (risk ratio [RR] = 0.84; 95% CI, 0.81-0.87; P