{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,7]],"date-time":"2026-09-07T19:15:59Z","timestamp":1788808559527,"version":"build-2803163510"},"reference-count":34,"publisher":"Wiley","issue":"12","license":[{"start":{"date-parts":[[2020,10,3]],"date-time":"2020-10-03T00:00:00Z","timestamp":1601683200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Academic Emergency Medicine"],"published-print":{"date-parts":[[2020,12]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Background<\/jats:title><jats:p>The risk factors for peri\u2010intubation cardiac arrest in critically ill children are incompletely understood. The study objective was to derive physiologic risk factors for deterioration during tracheal intubation in a pediatric emergency department (PED).<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>This was a retrospective cohort study of patients undergoing emergency tracheal intubation in a PED. Using the published literature and expert opinion, a multidisciplinary team developed high\u2010risk criteria for peri\u2010intubation arrest: 1) hypotension, 2) concern for cardiac dysfunction, 3) persistent hypoxemia, 4) severe metabolic acidosis (pH\u00a0&lt;\u00a07.1), 5) post\u2013return of spontaneous circulation (ROSC), and 6) status asthmaticus. We completed a structured review of the electronic health record for a historical cohort of patients intubated in the PED. The primary outcome was peri\u2010intubation arrest. Secondary outcomes included tracheal intubation success rate, extracorporeal membrane oxygenation (ECMO) activation, and in\u2010hospital mortality. We compared outcomes between patients meeting one or more versus no high\u2010risk criteria.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Peri\u2010intubation cardiac arrest occurred in 5.6% of patients who met at least one high\u2010risk criterion compared to 0% in patients meeting none (5.6% difference, 95% confidence interval [CI]\u00a0= 1.0 to 18.1, p\u00a0=\u00a00.028). Patients meeting at least one criterion had higher rates of any postintubation cardiac arrest in the PED (11.1% vs. 0%, 11.1% difference, 95% CI\u00a0= 4.1 to 25.3, p\u00a0=\u00a00.0007), in\u2010hospital mortality (25% vs. 2.3%, 22.7% difference, 95% CI\u00a0= 11.0 to 38.9, p\u00a0&lt;\u00a00.0001), ECMO activation (8.3% vs. 0%, 8.3% difference, 95% CI\u00a0= 2.5 to 21.8, p\u00a0=\u00a00.004), and lower likelihood of first\u2010pass intubation success (47.2% vs. 66.1%, \u221218.9% difference, 95% CI\u00a0= \u221235.5 to \u22121.5, p\u00a0=\u00a00.038), respectively.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>We have developed criteria that successfully identify physiologically difficult airways in the PED. Children with hypotension, persistent hypoxemia, concern for cardiac dysfunction, severe metabolic acidosis, status asthmaticus or who are post\u2010ROSC are at higher risk for peri\u2010intubation cardiac arrest and in\u2010hospital mortality. Further multicenter investigation is needed to validate our findings.<\/jats:p><\/jats:sec>","DOI":"10.1111\/acem.14128","type":"journal-article","created":{"date-parts":[[2020,9,28]],"date-time":"2020-09-28T18:08:25Z","timestamp":1601316505000},"page":"1241-1248","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":18,"title":["Identification of the Physiologically Difficult Airway in the Pediatric Emergency Department"],"prefix":"10.1111","volume":"27","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-4201-7372","authenticated-orcid":false,"given":"Preston N.","family":"Dean","sequence":"first","affiliation":[{"name":"From the Division of Emergency Medicine Cincinnati Children's Hospital Medical Center Cincinnati OH USA"},{"name":"the Department of Pediatrics University of Cincinnati College of Medicine Cincinnati OH USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Erin F.","family":"Hoehn","sequence":"additional","affiliation":[{"name":"From the Division of Emergency Medicine Cincinnati Children's Hospital Medical Center Cincinnati OH USA"},{"name":"the Department of Pediatrics University of Cincinnati College of Medicine Cincinnati OH USA"},{"name":"the Division of Emergency Medicine Children's Hospital of Pittsburgh of UPMC Pittsburgh PA USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gary L.","family":"Geis","sequence":"additional","affiliation":[{"name":"From the Division of Emergency Medicine Cincinnati Children's Hospital Medical Center Cincinnati OH USA"},{"name":"the Department of Pediatrics University of Cincinnati College of Medicine Cincinnati OH USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mary E.","family":"Frey","sequence":"additional","affiliation":[{"name":"From the Division of Emergency Medicine Cincinnati Children's Hospital Medical Center Cincinnati OH USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mary K.","family":"Cabrera\u2010Thurman","sequence":"additional","affiliation":[{"name":"From the Division of Emergency Medicine Cincinnati Children's Hospital Medical Center Cincinnati OH USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Benjamin T.","family":"Kerrey","sequence":"additional","affiliation":[{"name":"From the Division of Emergency Medicine Cincinnati Children's Hospital Medical Center Cincinnati OH USA"},{"name":"the Department of Pediatrics University of Cincinnati College of Medicine Cincinnati OH USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yin","family":"Zhang","sequence":"additional","affiliation":[{"name":"the Division of Biostatistics and Epidemiology Cincinnati Children's Hospital Medical Center Cincinnati OH USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Erika 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