Emergency intubation during thrombectomy for acute ischemic stroke in patients under primary procedural sedation

Neurological Research and Practice

Wolfgang Wick¹  Simon Schieber¹  Min Chen¹  Peter A. Ringleb¹  Silvia Schönenberger¹  Julian Bösel²  Markus A. Möhlenbruch³  Martin Bendszus³  Johannes A. R. Pfaff³  Dorothea Kronsteiner⁴  Meinhard Kieser⁴ 

[1] Department of Neurology, Heidelberg University Hospital, Im Neuenheimer Feld 400, Heidelberg, Germany;Department of Neurology, Heidelberg University Hospital, Im Neuenheimer Feld 400, Heidelberg, Germany;Department of Neurology, Kassel General Hospital, Kassel, Germany;Department of Neuroradiology, Heidelberg University Hospital, Heidelberg, Germany;Institute of Medical Biometry and Informatics, University of Heidelberg, Heidelberg, Germany;

关键词: Thrombectomy;    Acute ischemic stroke;    Sedation;    Emergency intubation;    Emergency conversion;   

DOI  :  10.1186/s42466-021-00125-0

来源: Springer

【 摘 要 】

BackgroundEmergency intubation is an inherent risk of procedural sedation regimens for endovascular treatment (EVT) of acute ischemic stroke. We aimed to characterize the subgroup of patients, who had to be emergently intubated, to identify predictors of the need for intubation and assess their outcomes.MethodsThis is a retrospective analysis of the single-center study KEEP SIMPLEST, which evaluated a new in-house SOP for EVT under primary procedural sedation. We used descriptive statistics and regression models to examine predictors and functional outcome of emergently intubated patients.ResultsTwenty of 160 (12.5%) patients were emergently intubated. National Institutes of Health Stroke Scale (NIHSS) on admission, premorbid modified Rankin scale (mRS), Alberta Stroke Program Early CT Score, age and side of occlusion were not associated with need for emergency intubation. Emergency intubation was associated with a lower rate of successful reperfusion (OR, 0.174; 95%-CI, 0.045 to 0.663; p = 0.01). Emergently intubated patients had higher in-house mortality (30% vs 6.4%; p = 0.001) and a lower rate of mRS 0–2 at 3 months was observed in those patients (10.5% vs 37%, p = 0.024).ConclusionsEmergency intubation during a primary procedural sedation regimen for EVT was associated with lower rate of successful reperfusion. Less favorable outcome was observed in the subgroup of emergently intubated patients. More research is required to find practical predictors of intubation need and to determine, whether emergency intubation is safe under strict primary procedural sedation regimens for EVT.

【 授权许可】

CC BY