Comparative Analysis of Tracheal Intubation-Associated Cardiac Arrest in 2015-2023: A Report From the National Emergency Airway Registry for Children Multicenter Registry
In brief
Cardiac arrest followed 1.2% of pediatric ICU intubations; each attempt raised the odds
In 27,773 intubations across 68 pediatric intensive care units, cardiac arrest or chest compressions occurred in 1.2%; each additional intubation attempt was associated with 70% higher odds. Video laryngoscopy and several medications were associated with lower odds, but this retrospective registry cannot establish that they prevent arrest, and the findings need to be interpreted in light of patients' illness severity.
- Journal
- Critical care medicine (Q1)
- Published
- 23 October 2026
- Study design
- Prospective / inception cohort
- Evidence level
- Level 2, Moderate (CEBM 2b)
- Authors
- Asif Padiyath, Febina Padiyath, Robert A Berg, Natalie Napolitano, Vinay Nadkarni, Justine Shults, et al.
- PMID
- 42919448
- DOI
- 10.1097/CCM.0000000000007390
Why clinicians should know about it
- Picked for Critical Care and Intensive Care Medicine (paper of the day, 26 October 2026): Large PICU registry study links intubation practices with cardiac arrest
Abstract
OBJECTIVES: To determine the contemporary incidence of tracheal intubation-associated cardiac arrest (TI-CA) in critically ill children and identify potentially modifiable factors to prevent TI-CA in PICUs and pediatric cardiac ICUs (PCICUs). DESIGN: Retrospective cohort study. SETTING: Seventy international PICUs and PCICUs. PATIENTS: Critically ill children requiring tracheal intubation in PICUs and PCICUs. INTERVENTIONS: Tracheal intubation data were prospectively collected for all initial intubations in 68 PICUs and PCICUs from January 2015 to December 2023 using the National Emergency Airway Registry for Children registry. MEASUREMENTS AND MAIN RESULTS: TI-CA was defined as CA occurrence or receipt of chest compressions for at least 1 minute within 20 minutes of endotracheal tube placement. TI during ongoing cardiopulmonary resuscitation was not considered TI-CA. A total of 27,773 TIs were evaluated, with TI-CA reported in 1.2% (n = 331). Pre-TI oxygenation failure and shock were associated with higher odds of TI-CA (adjusted odds ratio [aOR], 2.29; 95% CI, 1.81-2.89 and aOR, 4.67; 95% CI, 3.68-5.92, respectively). Each additional TI attempt required was associated with increased odds of TI-CA (aOR, 1.70; 95% CI, 1.56-1.85, for each attempt). Use of ketamine (aOR, 0.64; 95% CI, 0.49-0.82), propofol (aOR, 0.44; 95% CI, 0.27-0.72), neuromuscular blockade (aOR, 0.67; 95% CI, 0.49-0.91), and video laryngoscopy (aOR, 0.76; 95% CI, 0.6-0.97) were associated with lower odds of TI-CA. Mediation analysis indicated that 13% of video laryngoscopy's protective effect was due to a reduction in TI attempt counts. The protective effects of ketamine, propofol, and neuromuscular blockade were minimally mediated by reduced TI attempt counts (5%, 4%, and 7%). CONCLUSIONS: TI-CA occurred in 1.2% of TIs performed in the PICUs. Odds of TI-CA increased incrementally with successive TI attempts. Video laryngoscopy was protective against TI-CA. Mediation analysis revealed that reduced TI attempts accounted for 13% of the protective benefit associated with video laryngoscopy.
Abstract as published, via PubMed.
For healthcare professionals. The summary is generated by AI from the published abstract, and the evidence level is assigned automatically from the study design on the Oxford CEBM hierarchy. Neither is medical advice. Read the full paper before changing practice.