(336) Comparative Analysis of Cardiac Arrest and Non-Arrest Cases in the NEAR4KIDS Registry

Introduction: Cardiac arrest (CA) is a life-threatening complication associated with tracheal intubation (TI) in critically ill children. Prior studies demonstrated a 1.7% incidence of TI associated with CA (TI-CA) in this population. The objective is to determine the more recent incidence of TI-CA in critically ill children and to identify potentially modifiable factors for TI-CA. We hypothesize that in an ICU setting, the incidence of TI-CA is influenced by patient, provider, and practice factors. We also hypothesize the number of attempts is associated with the occurrence of TI-CA.

Methods: All pediatric patients ( < 18 years) from the National Emergency Airway Registry for Children (NEAR4KIDS) who underwent primary TI between 1/2015 and 12/2023 from 70 PICUs/CICUs were included. TIs for exchange of an existing tube are excluded. An explanatory model was developed to identify potentially modifiable risk factors with TI-CA vs. non-TI-CA as the outcome. Multivariable logistic regression was used to assess patient, provider, and practice factors. Further, we evaluated the impact of number of attempts on TI-CA occurrence.

Results: 44,603 TIs were reported from 2015-2023, and 382 (1.2%) had TI-CA. Oxygenation failure and shock as TI indication were associated with higher TI-CA occurrence (aOR 2.25, 95% CI: 1.79-2.83; aOR 4.38, 95% CI 3.41-5.62; respectively). Compared to attending performed TI, TIs by fellows and NPs had lower CA-TI occurrence. Ketamine and propofol use were associated with lower TI-CA (aOR 0.61, 95% CI 0.46-0.79; aOR 0.42, 95% CI 0.26-0.68; respectively). Use of VideoLaryngoscopy was associated with lower odds of TI-CA (aOR 0.79, 95% CI 0.63-0.99). Each additional TI attempt was significantly associated with TI-CA occurrence (aOR 1.80, 95% CI 1.65-1.96).

Conclusions: TI-CA occurred in 1.2% of TIs in the ICU, in this large contemporary NEAR4KIDS cohort. Number of attempts were positively and strongly associated with TI-CA. Use of ketamine and VideoLaryngoscopy were associated with lower TI associated cardiac arrests.