Shock Index as a Predictor of Post-Intubation Hypotension and Cardiac Arrest; A Review of the Current Evidence

Saqer M Althunayyan

Abstract

Endotracheal intubation is a lifesaving procedure that is performed in various settings within the hospital or even in the pre-hospital field. However, it can result in serious hemodynamic complications, such as post-intubation hypotension (PIH) and cardiac arrest. The most promising predictor of such complications is the shock index (SI), which holds great prognostic value for multiple disorders. On the other hand, most of the studies that have assessed the predictability of the pre-intubation SI have been small and were limited to a particular setting of a single center; thus, the results were not generalizable, and the predictive value vary according to the setting. This review comprehensively assessed the utility of the pre-intubation SI for predicting PIH and post-intubation cardiac arrest by classifying and comparing evidence compiled from various settings, such as pre-hospital settings, emergency departments (EDs), intensive care units (ICUs), and operating rooms (ORs). The vast majority of these studies, conducted in ED and ICU settings, which revealed a significant correlation between an elevated SI and PIH or post-intubation cardiac arrest. The reliability and simplicity of obtaining a pre-intubation SI value are important considerations that encourage the extension of its use to all in-hospital intubations. Further studies are required to assess the predictive value of the SI in the pre-hospital setting.

Keywords

Shock index; Intubation; Post-intubation hypotension; Cardiac arrest; Complication

Full Text:

PDF XML HTML

References

Green R, Edwards J, Sabri E, Fergusson D: Evaluation of the incidence, risk factors, and impact on patient outcomes of postintubation hemodynamic instability. CJEM 2012, 14:74-82.

Brown CA, Bair AE, Pallin DJ, Walls RM: Techniques, Success, and Adverse Events of Emergency Department Adult Intubations. Annals of Emergency Medicine 2015, 65.

Zenati MS, Billiar TR, Townsend RN, Peitzman AB, Harbrecht BG: A Brief Episode of Hypotension Increases Mortality in Critically Ill Trauma Patients. The Journal of Trauma: Injury, Infection, and Critical Care 2002, 53:232–237.

Shafi S, Gentilello L: Pre-Hospital Endotracheal Intubation and Positive Pressure Ventilation Is Associated with Hypotension and Decreased Survival in Hypovolemic Trauma Patients: An Analysis of the National Trauma Data Bank. The Journal of Trauma: Injury, Infection, and Critical Care 2005:1140–1147.

Holler J, Henriksen D, Mikkelsen S, Pedersen C, Lassen A: Incidence and mortality of hypotension in the emergency department; an 12-year population based study. Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine 2015, 23(Suppl 1):A22.

Allgöwer M, Burri C. Shock-index. German medical monthly. 1968;13(1):14.

Rady MY, Smithline HA, Blake H, Nowak R, Rivers E: A Comparison of the Shock Index and Conventional Vital Signs to Identify Acute, Critical Illness in the Emergency Department. Annals of Emergency Medicine 1994, 24:685–690.

Olaussen A, Blackburn T, Mitra B, Fitzgerald M: Review article: Shock Index for prediction of critical bleeding post-trauma: A systematic review. Emergency Medicine Australasia 2014, 26:223–228.

Zhang X, Wang Z, Wang Z, Fang M, Shu Z: The prognostic value of shock index for the outcomes of acute myocardial infarction patients: A systematic review and meta-analysis. Medicine 2017, 96.

Pacagnella RC, Durocher J, Perel P, Blum J, Winikoff B, Gulmezoglu AM, Souza JPP: A Systematic Review of the Relationship between Blood Loss and Clinical Signs. PLoS ONE 2013, 8(3).

Heffner AC, Swords D, Kline JA, Jones AE: The frequency and significance of postintubation hypotension during emergency airway management. Journal of Critical Care 2012, 27.

Franklin C, Samuel J, Hu T-C: Life-threatening hypotension associated with emergency intubation and the initiation of mechanical ventilation. The American Journal of Emergency Medicine 1994, 12:425–428.

Heffner AC, Swords DS, Nussbaum ML, Kline JA, Jones AE: Predictors of the complication of postintubation hypotension during emergency airway management. Journal of Critical Care 2012, 27:587–593.

Koby A, Nwokolo J, Horn A, Banapoor B, Marchick M, Beattie L: Florida College of Emergency Physicians Symposium by the Sea. In Using pre-Rapid Sequence Intubation Shock Index as a predictor of post-intubation hypotension, mortality, and duration of intubation. August(2015) ; 0AD

Kim J, Lee K, Kim I, Cha M, Kim M: The Potential Factors and the Outcomes of Hypotensive Patients after Emergent Endotracheal Intubation. Journal of The Korean Society of Emergency Medicine 2016, 27:293-300.

Corey J, Stephanie W, Lars B, Michael M: SAEM Annual Meeting Abstracts .508 - The Association of Shock Indices With Post-intubation Hypotension in Trauma and Medical Patients. Academic Emergency Medicine 2017, 24:182

Ko BS, Ahn R, Ryoo SM, Ahn S, Sohn CH, Seo DW, Lim KS, Kim WY: Prevalence and outcomes of endotracheal intubation-related cardiac arrest in the ED. The American Journal of Emergency Medicine 2015, 33:1642–1645.

Heffner AC, Swords DS, Neale MN, Jones AE: Incidence and factors associated with cardiac arrest complicating emergency airway management. Resuscitation 2013, 84:1500–1504

Sanchez LD, Goudie JS, Pena J, Ban K, Fisher J: Mortality after emergency department intubation. International Journal of Emergency Medicine 2008, 1:131–133

Newland MC, Ellis SJ, Lydiatt CA, Peters KR, Tinker JH, Romberger DJ, Ullrich FA, Anderson JR: Anesthestic-related Cardiac Arrest and Its Mortality. Anesthesiology 2002, 97:108–115.

Arbous MS, Grobbee DE, Kleef JWV, Lange JJD, H. H. A. J. M. Spoormans, Touw P, Werner FM, Meursing AEE: Mortality associated with anaesthesia: a qualitative analysis to identify risk factors. Anaesthesia 2008, 56:1141–1153.

Kim W, Kwak M, Ko B, Yoon J, Sohn C, Lim K, Andersen L, Donnino M: Factors Associated with the Occurrence of Cardiac Arrest after Emergency Tracheal Intubation in the Emergency Department. PLoS ONE 2014, 9:e112779.

Vyas A, Vyas D, Minokadeh A, Sell R: 196:Post intubation cardiac arrest: an institutional review of a potential preventable catastrophe. Critical Care Medicine 2015, 43:50.

Smischney NJ, Demirci O, Diedrich DA, Barbara DW, Sandefur BJ, Trivedi S, Mcgarry S, Kashyap R: Incidence of and Risk Factors For Post-Intubation Hypotension in the Critically Ill. Medical Science Monitor 2016, 22:346–355

Green RS, Turgeon AF, Mcintyre LA, Fox-Robichaud AE, Fergusson DA, Doucette S, Butler MB, Erdogan M: Postintubation hypotension in intensive care unit patients: A multicenter cohort study. Journal of Critical Care 2015, 30:1055–1060

Jaber S, Amraoui J, Lefrant J, Arich C, Cohendy R, Landreau L, Calvet Y, Capdevila X, Mahamat A, Eledjam J: Clinical practice and risk factors for immediate complications of endotracheal intubation in the intensive care unit: A prospective, multiple-center study*. Critical Care Medicine 2006, 34:2355-2361.

Trivedi S, Demirci O, Arteaga G, Kashyap R, Smischney NJ: Evaluation of preintubation shock index and modified shock index as predictors of postintubation hypotension and other short-term outcomes. Journal of Critical Care 2015, 30

Wardi G, Villar J, Nguyen T, Vyas A, Pokrajac N, Minokadeh A, Lasoff D, Tainter C, Beitler JR, Sell RE: Factors and outcomes associated with inpatient cardiac arrest following emergent endotracheal intubation. Resuscitation 2017, 121:76–80

Smischney NJ, Seisa MO, Cambest J, Wiegand RA, Busack KD, Loftsgard TO, Schroeder DR, Diedrich DA: The Incidence of and Risk Factors for Postintubation Hypotension in the Immunocompromised Critically Ill Adult. Journal of Intensive Care Medicine 2017:088506661770484

Smischney NJ, Seisa MO, Heise KJ, Wiegand RA, Busack KD, Deangelis JL, Loftsgard TO, Schroeder DR, Diedrich DA: Predictors of hemodynamic derangement during intubation in the critically ill: A nested case-control study of hemodynamic management-Part II. Journal of Critical Care 2018, 44:179–184

5. NIKOLINA B, VIŠNJA A, Nika J, Tatjana G, Miroslava J, Medved T: Postintubation hypotension in elective surgery patients: a retrospective study. Signa Vitae - A Journal In Intensive Care And Emergency Medicine 2018, 14:31-34.

6. Green R, Butler M: Postintubation Hypotension in General Anesthesia. Journal of Intensive Care Medicine 2016, 31:667-675.

Walker RG, White LJ, Whitmore GN, Esibov A, Levy MK, Cover GC, Edminster JD, Nania JM: Evaluation of Physiologic Alterations during Prehospital Paramedic-Performed Rapid Sequence Intubation. Prehospital Emergency Care 2018, 22:300–311

Vopelius-Feldt JV, Benger JR: Prehospital anaesthesia by a physician and paramedic critical care team in Southwest England. European Journal of Emergency Medicine 2013, 20:382–386

Sollid S, Lossius H, Søreide E: Pre-hospital intubation by anaesthesiologists in patients with severe trauma: an audit of a Norwegian helicopter emergency medical service. Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine 2010, 18:30.

Miller M, Kruit N, Heldreich C, Ware S, Habig K, Reid C, Burns B: Hemodynamic Response After Rapid Sequence Induction With Ketamine in Out-of-Hospital Patients at Risk of Shock as Defined by the Shock Index. Annals of Emergency Medicine 2016, 68.

Sheth MK, Brand A, Halterman J: Ketamine-induced Changes in Blood Pressure and Heart Rate in Pre-hospital Intubated Patients. Advanced Journal of Graduate Research 2018, 3:20–33.

Panchal A, Satyanarayan A, Bahadir J, Hays D, Mosier J: Efficacy of Bolus-dose Phenylephrine for Peri-intubation Hypotension. The Journal of Emergency Medicine 2015, 49:488-494.

8. Kamenik M, Kos D, Petrun A, Green D, Zorko N, Mekiš D: Haemodynamic stability during anaesthesia induction with propofol – impact of phenylephrine. A double-blind, randomised clinical trial. Signa Vitae - A Journal In Intensive Care And Emergency Medicine 2018, 14.

Levitan R. Timing Resuscitation Sequence Intubation for Critically Ill Patients – ACEP Now [Internet]. ACEP Now. 2015 [cited 23 may 2018]. Available from: http://www.acepnow.com/article/timing-resuscitation-sequence-intubation-for-critically-ill-patients/

El-Beheiry H, Kim J, Milne B, Seegobin R: Prophylaxis against the systemic hypotension induced by propofol during rapid-sequence intubation. Canadian Journal of Anaesthesia 1995, 42:875–878.

Takahashi J, Goto T, Okamoto H, Hagiwara Y, Watase H, Shiga T, Hasegawa K: Association of fentanyl use in rapid sequence intubation with post-intubation hypotension. The American Journal of Emergency Medicine 2018

Chiu M-T, Chen C-M, Lin C-C, Li C-H, Chaou C-H, Chen H-Y, Chen K-F: Evaluation of the association between postintubation hypotension and lidocaine administered as a premedication for rapid sequence intubation: A comparison between traditional regression methods and propensity score matching-based method. Journal of Acute Medicine 2013, 3:33–38