Abstract Body: Background:
Pediatric life support guidelines defer recommendation for or against intra-arrest intubation during IHCA. A prior observational study (2000-2014) identified an association of intra-arrest intubation with lower rates of survival to hospital discharge (SHD). Changes in clinical practice (e.g., patient selection, delaying intubation, CPR quality) may have mitigated potential harm.

Aim:
Determine the association between intra-arrest intubation and SHD in a recent cohort of children with IHCA.

Hypothesis:
Intra-arrest intubation is associated with increased odds of SHD.

Methods:
Retrospective cohort study of children with index IHCA without an invasive airway at time of CPR in the Get with the Guidelines registry from 2000-2022. We performed a time-dependent propensity-score matched analysis. Patients intubated in a given minute were matched with patients at-risk of intubation in the same minute based on a propensity score derived from multiple patient, arrest and hospital characteristics, with forced matching on stratification variables (age group, illness category) and replacement of controls. We assessed the association between intra-arrest intubation and SHD using a mixed-effects logistic regression model, with random effects to account for matched data and clustering by hospital, and weighting for the number of times a patient was included as a control.

Results:
Of 3,262 patients with median age 1 [IQR: 0.3, 8] years, 2,164 (66.3%) were intubated, and 1,748 (53.6%) survived to hospital discharge. Intubation rates decreased from 84.6% to 66.7% across the study period (Figure 1, non-parametric test for trend, p<0.001). Median time to intubation was 7 [4, 12] minutes and increased across the study period (p<0.001). In the recent cohort (2017-2022, n=1192), there was no association between intra-arrest intubation and SHD (aOR 1.18, 95% CI: 0.90, 1.53). In a subgroup analysis of children >8 years, being intubated compared to not being intubated in a given minute was associated with increased odds of SHD (aOR 1.91, 95% CI: 1.09, 3.33) (Figure 2).

Conclusions: In a recent (2017-2022) cohort of children with IHCA, intra-arrest intubation was not associated with increased odds of survival to hospital discharge. In a subgroup of children >8 years, intra-arrest intubation was associated with increased odds of survival. We speculate that secular changes in airway management may partially explain the lack of harm identified in our recent cohort.