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. 2015 Jul 21;10(7):e0132612.
doi: 10.1371/journal.pone.0132612. eCollection 2015.

Prevalence and Predictors of Gastrostomy Tube and Tracheostomy Placement in Anoxic/Hypoxic Ischemic Encephalopathic Survivors of In-Hospital Cardiopulmonary Resuscitation in the United States

Veerajalandhar Allareddy  1 , Sankeerth Rampa  2 , Romesh P Nalliah  3 , Natalia I Martinez-Schlurmann  1 , Karen B Lidsky  1 , Veerasathpurush Allareddy  4 , Alexandre T Rotta  1
Affiliations

Prevalence and Predictors of Gastrostomy Tube and Tracheostomy Placement in Anoxic/Hypoxic Ischemic Encephalopathic Survivors of In-Hospital Cardiopulmonary Resuscitation in the United States

Veerajalandhar Allareddy et al. PLoS One. .

Abstract

Introduction: Current prevalence estimates of gastrostomy tube (GT)/tracheostomy placement in hospitalized patients with anoxic/hypoxic ischemic encephalopathic injury (AHIE) post cardiopulmonary resuscitation (CPR) are unknown. We sought, to estimate the prevalence of AHIE in hospitalized patients who had CPR and to identify patient/hospital level factors that predict the performance of GT/tracheostomy in those with AHIE.

Methods: We performed a retrospective analysis of the Nationwide Inpatient Sample (years 2004-2010). All patients who developed AHIE following CPR were included. In this cohort the odds of having GT and tracheostomy was computed by multivariable logistic regression analysis. Patient and hospital level factors were the independent variables.

Results: During the study period, a total of 686,578 CPR events occurred in hospitalized patients. Of these, 94,336 (13.7%) patients developed AHIE. In this AHIE cohort, 6.8% received GT and 8.3% tracheostomy. When compared to the 40-49 yrs age group, those aged >70 yrs were associated with lower odds for GT (OR = 0.65, 95% CI:0.53-0.80, p<0.0001). Those aged <18 years & those >60 years were associated with lower odds for having tracheostomy when compared to the 40-49 years group (p<0.0001). Each one unit increase in co-morbid burden was associated with higher odds for having GT (OR = 1.23,p<0.0001) or tracheostomy (OR = 1.17, p<0.0001). Blacks, Hispanics, Asians/Pacific Islanders, and other races were associated with higher odds for having GT or tracheostomy when compared to whites (p<0.05). Hospitals located in northeastern regions were associated with higher odds for performing GT (OR = 1.48, p<0.0001) or tracheostomy (OR = 1.63, p<0.0001) when compared to those in Western regions. Teaching hospitals (TH) were associated with higher odds for performing tracheostomy when compared to non-TH (OR = 1.36, 1.20-1.54, p<0.0001).

Conclusions: AHIE injury occurs in a significant number of in-hospital arrests requiring CPR. Certain predictors of GT/ Tracheostomy placement are identified. Patients in teaching hospitals were more likely to receive tracheostomy than their counterparts.

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Conflict of interest statement

Competing Interests: The authors have declared that no competing interests exist.

Figures

Fig 1
Fig 1. The left axis depicts the number of gastrostomy tube (G Tube, black triangles) and tracheostomy (Trach, white triangles) procedures relative to the number of cardiopulmonary resuscitation (CPR, black circles) events and acute hypoxic ischemic encephalopathy (AHIE, white circles) between the years of 2004 and 2010 (inclusive).
The right axis depicts the percentage of patients who developed AHIE following CPR and the proportion of those receiving a G Tube, Trach, or no G Tube or Trach.
See this image and copyright information in PMC

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