Reverse shock index (RSI) as a predictor of post-intubation cardiac arrest (PICA).
Cardiac arrest
Emergency department
Intubation
Vital signs
Journal
International journal of emergency medicine
ISSN: 1865-1372
Titre abrégé: Int J Emerg Med
Pays: England
ID NLM: 101469435
Informations de publication
Date de publication:
07 Dec 2023
07 Dec 2023
Historique:
received:
28
09
2023
accepted:
01
12
2023
medline:
8
12
2023
pubmed:
8
12
2023
entrez:
7
12
2023
Statut:
epublish
Résumé
Endotracheal intubation (ETI) in critically ill patients is a high-risk procedure due to the increased risk of cardiac arrest, and several factors may predict poor outcomes in these patients. The aim of this study was to investigate the role of some factors, especially newly introduced vital signs such as the reverse shock index (RSI), in predicting post-intubation cardiac arrest (PICA) in critically ill adult patients. This cross-sectional study was conducted on critically ill patients over 18 years of age who were admitted to the emergency department (ED) and underwent ETI within 1 year. Patients who developed PICA and those without this event were included in the study, and their features were compared. The primary outcome was cardiac arrest. Of 394 patients, 127 patients were included, of whom 95 (74.8%) developed PICA, and 32 (25.2%) did not experience cardiac arrest after intubation. In multivariate analysis, age, RSI, oxygen saturation, and total bilirubin were significantly associated with PICA. In addition, patients with RSI < 1 had a significantly higher risk of developing PICA (odds ratio = 5.22, 95% CI 1.83-14.86, p = 0.002). The sensitivity, specificity, positive predictive value, negative predictive value, and diagnostic accuracy for predicting PICA were 51.11%, 83.33%, 90.2%, 36.23%, and 59.17%, respectively. The ROC curve for RSI showed an area under the curve (AUC) of 0.66. RSI may be useful in predicting PICA with higher diagnostic accuracy compared to the shock index. Furthermore, advanced age, hypoxia, and hyperbilirubinemia may increase the risk of PICA in patients admitted to the ED.
Sections du résumé
BACKGROUND
BACKGROUND
Endotracheal intubation (ETI) in critically ill patients is a high-risk procedure due to the increased risk of cardiac arrest, and several factors may predict poor outcomes in these patients. The aim of this study was to investigate the role of some factors, especially newly introduced vital signs such as the reverse shock index (RSI), in predicting post-intubation cardiac arrest (PICA) in critically ill adult patients.
METHODS
METHODS
This cross-sectional study was conducted on critically ill patients over 18 years of age who were admitted to the emergency department (ED) and underwent ETI within 1 year. Patients who developed PICA and those without this event were included in the study, and their features were compared. The primary outcome was cardiac arrest.
RESULTS
RESULTS
Of 394 patients, 127 patients were included, of whom 95 (74.8%) developed PICA, and 32 (25.2%) did not experience cardiac arrest after intubation. In multivariate analysis, age, RSI, oxygen saturation, and total bilirubin were significantly associated with PICA. In addition, patients with RSI < 1 had a significantly higher risk of developing PICA (odds ratio = 5.22, 95% CI 1.83-14.86, p = 0.002). The sensitivity, specificity, positive predictive value, negative predictive value, and diagnostic accuracy for predicting PICA were 51.11%, 83.33%, 90.2%, 36.23%, and 59.17%, respectively. The ROC curve for RSI showed an area under the curve (AUC) of 0.66.
CONCLUSION
CONCLUSIONS
RSI may be useful in predicting PICA with higher diagnostic accuracy compared to the shock index. Furthermore, advanced age, hypoxia, and hyperbilirubinemia may increase the risk of PICA in patients admitted to the ED.
Identifiants
pubmed: 38062359
doi: 10.1186/s12245-023-00569-y
pii: 10.1186/s12245-023-00569-y
pmc: PMC10702001
doi:
Types de publication
Journal Article
Langues
eng
Pagination
88Informations de copyright
© 2023. The Author(s).
Références
Crit Care. 2019 May 6;23(1):158
pubmed: 31060580
ESC Heart Fail. 2022 Oct;9(5):3232-3240
pubmed: 35775109
Am J Emerg Med. 2016 Jan;34(1):63-8
pubmed: 26602240
Int J Environ Res Public Health. 2016 May 25;13(6):
pubmed: 27231926
Am J Emerg Med. 2015 Nov;33(11):1642-5
pubmed: 26324004
Front Med (Lausanne). 2021 Oct 04;8:697027
pubmed: 34671613
Acute Crit Care. 2019 Aug;34(3):212-218
pubmed: 31723930
Open Access Emerg Med. 2019 Aug 14;11:179-199
pubmed: 31616192
Am J Emerg Med. 2022 Aug;58:229-234
pubmed: 35716536
Resuscitation. 2021 May;162:403-411
pubmed: 33684505
Am J Emerg Med. 2023 Sep;71:200-216
pubmed: 37437438
Am J Respir Crit Care Med. 2022 Aug 15;206(4):449-458
pubmed: 35536310
Crit Care Med. 2018 Apr;46(4):532-539
pubmed: 29261566
JAMA. 2022 Jul 19;328(3):270-279
pubmed: 35707974
Resuscitation. 2016 Aug;105:59-65
pubmed: 27241332
Front Med (Lausanne). 2022 Nov 22;9:999481
pubmed: 36482909
Ulus Travma Acil Cerrahi Derg. 2023 Jul;29(7):786-791
pubmed: 37409920
J Intensive Care Med. 2015 Jan;30(1):23-9
pubmed: 23753252
JAMA. 2017 Feb 7;317(5):494-506
pubmed: 28118660
Scand J Trauma Resusc Emerg Med. 2016 Feb 09;24:12
pubmed: 26861172
BMC Emerg Med. 2020 Oct 31;20(1):87
pubmed: 33129277
Int J Environ Res Public Health. 2016 Mar 24;13(4):357
pubmed: 27023577
Int J Environ Res Public Health. 2018 Oct 24;15(11):
pubmed: 30355971
Cureus. 2021 May 22;13(5):e15178
pubmed: 34178499
Br J Anaesth. 2012 May;108(5):792-9
pubmed: 22315326
PLoS One. 2014 Nov 17;9(11):e112779
pubmed: 25402500
Source Code Biol Med. 2008 Dec 16;3:17
pubmed: 19087314
J Anesth. 2019 Jun;33(3):454-462
pubmed: 30900042
Am J Emerg Med. 2023 May;67:79-83
pubmed: 36806979
Resuscitation. 2017 Dec;121:76-80
pubmed: 29032298
J Crit Care. 2017 Aug;40:31-35
pubmed: 28314169
PLoS One. 2020 Aug 31;15(8):e0233852
pubmed: 32866219
Bull Emerg Trauma. 2019 Jan;7(1):21-27
pubmed: 30719462
Int J Surg. 2023 May 01;109(5):1231-1238
pubmed: 37222717