CARDIAC-ARREST AS A POSSIBLE SEQUELA OF CRITICAL AIRWAY MANAGEMENT AND INTUBATION

Immediate cardiac arrest may occur as a result of the physiological co nsequences of critical airway management, which may include one or all of the following: (1) sedation and/or paralysis, (2) tracheal intubat ion, and (3) positive pressure ventilation. Two patients are reported, both with myocarditis, who developed cardiac arrest within minutes of simple intubations, Their arrests were not related to technical diffi culties of critical airway management, Any disease process that create s a preload dependent cardiovascular system also creates a situation w herein critical airway management may cause cardiac decompensation. Al l medications administered to sedate patients and facilitate intubatio n, as well as mechanical Ventilation itself, can cause a decrease in p reload, This may be a significant mechanism through which immediate de compensation occurs, Potential conditions that cause preload-dependent cardiovascular systems, as well as alternate therapeutic consideratio ns, are outlined, In these patients intubations should not be delayed, but should be done with extreme caution in anticipation of possible c ardiac arrest, (Am J Emerg Med 1998;16:609-612 Copyright (C) 1998 by W .B. Saunders Company).