Peri-intubation cardiac arrest (PICA) is infrequent but a serious complication of intubation, especially in an emergency. Hoehn et al reported a system of care that provides additional support to manage patients at increased risk in the Emergency Department. The authors are from Cincinnati Children's Hospital and Children’s Hospital of Pittsburgh of UPMC.

Patient selection: intubation in the Emergency Department


Outcome: peri-intubation cardiac arrest (PICA)


Frequency of PICA: 1.7%


Criteria for high-risk patient:

(1) hypotension for age (see below)

(2) clinical concern for cardiac dysfunction (based on worsening oxygenation or hemodynamics with fluids)

(3) persistent hypoxemia with SpO2 less than 90% despite oxygen supplementation or positive pressure

(4) severe metabolic acidosis (pH < 7.1)

(5) post return of spontaneous circulation (ROSC)

(6) status asthmaticus




<= 30 days

MAP < 40 mm Hg

31 to 365 days

MAP < 45 mm Hg

1 to 2 years

MAP < 50 mm Hg

2.01 to 6 years

MAP < 55 mm Hg

6.01 to 13 years

MAP < 60 mm Hg

> 13 years

MAP < 65 mm Hg


If any of the criteria are met, then a team from the PICU is on hand to respond to a cardiac arrest if it occurs.

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