Intubation During In-Hospital CPR Decreases Survival and Neurological Outcomes

by Joseph Esherick, M.D., FAAFP, FHM

This study was an observational cohort study of adult patients who had an in-hospital cardiac arrest between 2000 through 2014.   A US-based multicenter registry of in-hospital cardiac arrest was studied and included 108,079 adult patients at 668 hospitals.

Two groups were identified:  those patients who underwent endotracheal intubation within the first 15 minutes of CPR and those patients who were managed without endotracheal intubation.  The investigators found that patients who underwent tracheal intubation during the first 15 minutes of CPR had a statistically significant decreased survival rate 16.3% vs 19.4%, respectively (risk ratio [RR] = 0.84; 95% CI, 0.81-0.87; P < .001.  In addition, patients who underwent tracheal intubation had a lower rate of a good functional outcome compared to those who did not undergo intubation (10.6% vs 13.6%, respectively (RR = 0.78; 95% CI, 0.75-0.81; P < .001.

Although this was an observational cohort study, the large number of patients studied and the statistically significant p values supports the 2015 ACLS guidelines to withhold endotracheal intubation in most cardiac arrest cases. 

Reference:

Association Between Tracheal Intubation During Adult In-Hospital Cardiac Arrest and Survival.  JAMA. 2017;317(5):494-506.