In this episode, I’ll discuss how to predict the risk of cardiac arrest after intubation.
A retrospective analysis of 64 ICUs in France determined the prevalence of and risk factors for cardiac arrest during intubation in ICU.
A total of 1,847 intubation procedures were included in the analysis. The incidence of intubation-related cardiac arrest was 2.7%.
In multivariate analysis, the main predictors of intubation-related cardiac arrest were systolic blood pressure < 90 mm Hg prior to intubation (odds ratio = 3.406), hypoxemia prior to intubation (odds ratio = 3.99), absence of pre-oxygenation (odds ratio = 3.584), body mass index > 25 (odds ratio = 2.005), and age more than 75 years old (odds ratio = 2.251).
Three of the 5 risk factors are potentially modifiable:
* Systolic BP < 90 mmHg
* Hypoxia
* Absence of pre-oxygenation
Of these, the factor with the most potential for a pharmacist to impact is the systolic blood pressure.
A pharmacist at the bedside can make sure that vasopressors and fluids are available and being used optimally to establish a systolic above 90 prior to intubation whenever possible. In addition, if patient agitation is preventing adequate pre-oxygenation, a pharmacist can facilitate providing sedation with medications such as dexmedetomidine or ketamine that would allow for pre-oxygenation to take place.
Finally, if multiple risk factors are present, consider preparing in advance by having the code cart in the room so that in the event of an intubation-related cardiac arrest, supplies and medications to treat the patient are readily available.
To get a pdf of tips for pharmacists who respond to code blue and rapid response calls go to my free download area at pharmacyjoe.com/free. It’s download number 16 on the list.
If you like this post, check out my book – A Pharmacist’s Guide to Inpatient Medical Emergencies: How to respond to code blue, rapid response calls, and other medical emergencies.
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