Peri-intubation adverse events and clinical outcomes in emergency department patients: the BARCO study
Year: 2025
Type: article
Study design: Observational Study
Abstract: BACKGROUND: Emergency tracheal intubation in critically ill patients carries a high risk of complications, and practices vary substantially across different settings. Identifying risk factors and understanding how peri-intubation adverse events affect patient outcomes may guide standardization of care and improve survival. METHODS: This prospective cohort study involved 18 emergency departments in Brazil (March 2022-April 2024). We included adults (≥ 18 years) undergoing emergency intubation and excluded patients intubated electively or for cardiac arrest. We defined major peri-intubation adverse events as severe hypoxemia, new hemodynamic instability, or cardiac arrest occurring within 30 min of initiating intubation. The primary outcome was 28-day mortality. Multivariable regression analyses assessed associations between adverse events and mortality, controlling for potential confounders. RESULTS: Among 2846 patients, major adverse events occurred in 919 (32.3%) intubations, most frequently new hemodynamic instability (20.0%), followed by severe hypoxemia (12.5%) and cardiac arrest (3.5%). The overall 28-day mortality was 45.1%. Patients experiencing any major adverse event had a significantly higher 28-day mortality (57.6 vs 39.2%; aHR 1.43, 95% CI 1.26-1.62; p < 0.001). Sensitivity analyses confirmed these findings. Successful first-attempt intubation was associated with a reduced likelihood of major adverse events (aOR 0.52; 95% CI 0.41-0.65; p < 0.001). CONCLUSION: One in three patients undergoing emergency intubation experienced a major peri-intubation adverse event, which was associated with higher 28-day mortality. These results underscore the importance of optimizing intubation strategies to reduce complications and potentially improve patient outcomes in critically ill patients.
Source: Critical Care
Authors: Ian Ward A. Maia, Bruno A. M. Pinheiro Besen, Lucas Oliveira J. e Silva, Rafael von Hellmann, Ludhmila Abrahao Hajjar, Benjamin J. Sandefur, Daniel Fontana Pedrollo, Caio Goncalves Nogueira, Natalia Mansur P. Figueiredo, Carlos Henrique Miranda, Danilo Martins, Thiago Dias Baumgratz, Bruno Bergesch, Diogo Costa, Osmar Colleoni, Juliana Zanettini, Ana Paula Freitas, Nicole Pinheiro Moreira, Patricia Lopes Gaspar, Renato Tambelli, Maria Cristina Costa, Samara Silveira, Wilsterman Correia, Rafael Garcia de Maria, Ubirajara A. Vinholes Filho, Andre P. Weber, Vinicius da Silva Castro, Carlos Fernando D. Dornelles, Barbara S. Tabach, Hélio P. Guimarães, Gabriela Stanzani, Thiago F. Gava, Aidan Mullan, Heraldo P. Souza, Otavio T. Ranzani, Fernanda Bellolio, Julio C. G. Alencar, the BARCO group, Victor Paro da Cunha, Julio F. Marchini, Patricia Albuquerque Moura, Fernanda Greco, Yasmine Filippo, Rubens Yoshinori Kai, Guilherme Torres Abi Ramia Chimelli, Juan Valdivia, Edson Luiz Favero Junior, Felipe Rischini, Vitor Amorim de Andrade Câmara, Henrique Bertotto, Victor Borges, Juliano Rathke, Renato Melo, Ariadine Augusta Maiante, Sarah Maciel Silva, Clarisse Moreira Ribeiro de Oliveira, Andressa Pi Rocha Reis, Thamyres de Carvalho Rufato, Gabriella Dias, Victoria Sartor Poloni, Kauê Lima, Hilana Zenly, José Carlos Motta, Gabriel Miranda, Alexandre Freitas, Leonardo Gasperini, Thais Raimondi Sudbrack, Ana Paula Ribeiro, Guilherme Henrique A. do Carmo, Andrea de Vargas Tomelero, Augusto Lengler Konrath, Vitor Cremonese Zanella, Natalia Fuhr, Davi Amaral Cesário Rosa, Isabela Lopes Lima, Luiz Fernando Varela, Isabella Baldino, Andre Zimerman, Julia M. Dorn de Carvalho, Molly M. Jeffery
Institutions: Mayo Clinic, Universidade de São Paulo, Universidade Federal do Rio Grande do Sul, Hospital de Clínicas de Porto Alegre, Monash Health, Hospital Regional de São José Dr. Homero de Miranda Gomes, Hospital São Lucas da PUCRS, Pontifícia Universidade Católica do Rio Grande do Sul, Hospital Geral de Fortaleza, Faculdade de Medicina de Marília, Governo de Santa Catarina, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, Barcelona Institute for Global Health, Instituto do Coração - HCFMUSP
Language: English
Subfield: Anesthesiology and Pain Medicine
Field: Medicine
Domain: Health Sciences
Open Access status: gold
Estimated APC paid: $4,190
OpenAlex ID: W4409528681