Assassin’s Creed & Preintubation hypotension

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Okay in Resuscitation Journal advanced access this month, this retrospective study of emergency intubations using RSI in an ED was done to examine peri-intubation cardiac arrest and factors that might influence the risk of this adverse event.

Incidence and Factors Associated with Cardiac Arrest Complicating Emergency Airway Management.

This article fits in nicely with an EMCrit episode just released on Hemodynamic kills in the Laryngoscope is a Murder Weapon series by Scott Weingart, our good friend!

Take home points from this article:

  1. Preintubation hypotension defined as SBP<90 was associated 4 times as often with cardiac arrest within 10 minutes of intubation
  2. PEA was the most common arrest scenario with emergency intubation
  3. Number of intubation attempts and preintubation oxygen saturation were not found to be significantly associated with perintubation arrest (doubtful as other studies have shown plausible strong associations!)
  4. RSI drugs and pressor agents used were not documented as part of the analysis..so who knows..maybe propofol was used a lot here ?? 😉
  5. The authors note, traditional ABC approach to resuscitation, places haemodynamic priorities lower than Airway and breathing and their study indicates it may well need to be a much higher priority especially when undertaking emergency airway interventions like RSI.
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