Perioperative cardiac arrests – A subanalysis of the anesthesia -related cardiac arrests and associated mortality

• Published in: Journal of clinical anesthesia 2018-11, Vol.50, p.78-90
• Main Authors: Sobreira-Fernandes, Diogo, Teixeira, Laetitia, Lemos, Tiago S., Costa, Liliana, Pereira, Manuela, Costa, António C., Couto, Paula S.
• Format: Article
• Language: English
• Subjects: Anesthesia; Anesthesiology; Cardiac arrhythmia; Cardiopulmonary arrest; Hospital; Hospitals; Incident reporting; Intensive care; Mortality; Observational studies; Patient safety; Patients; Perioperative period; Retrospective observational study; Risk factors; Surgery; Working hours
• ISSN: 0952-8180; 1873-4529
• DOI: 10.1016/j.jclinane.2018.06.005

To determine the incidence, risk factors, and predictors of survival of perioperative cardiac arrests (PCAs) occurring in patients who underwent non-cardiac and non-obstetric surgery from January 2008 to May 2015 at a tertiary hospital; determine the incidence and risk factors of anesthesia-related PCA. Retrospective observational study. Operating room and postoperative recovery area. Sixty-two PCA cases from an anesthesia database of 122,289 anesthetics. Each PCA was classified as anesthesia-related, partially anesthesia-related, or anesthesia unrelated. The main outcome variables were occurrence of PCA, survival at least 1 h after initial resuscitation and survival to hospital discharge. To determine the risk factors for PCA, for each patient who suffered a PCA, two other patients that underwent anesthesia on the same day and in the same operating suite were selected. Three sets of variables were collected; patient-related, surgical procedure-related, and PCA-related. The incidence of PCAs of all causes was 5.07 per 10,000 anesthetics, and the associated mortality was 2.9 per 10,000 anesthetics. The independent risk factors for occurrence were: ASA PS score higher than 3, diagnosed cardiac disease, and the use of vasopressors. Decreased survival was associated with: higher ASA PS score, urgent surgical procedures of a higher complexity, use of vasopressors, documented hypotension prior to PCA, and arrests due to bleeding. The incidence of anesthesia-related PCAs was 0.74 per 10,000 anesthetics, and the associated mortality was 0.08 per 10,000 anesthetics. The main causes of anesthesia-related PCAs were associated with medication and airway/ventilation, and the independent risk factors for occurrence were: ASA PS score higher than 3 and diagnosed cardiac disease. Most PCAs were not due to anesthesia-related causes, and anesthesia-related PCAs were associated with improved survival. Improvements in the management of high-risk patients, medication administration, and airway/ventilation management may result in better outcomes. •62 cases of PCA over 7 years from an anesthesia database of 122,289 anesthetics•Overall incidence of PCA from all causes was 5.07 per 10,000 anesthetics.•Incidence of anesthesia-related PCA was 0.74 per 10,000.•Anesthesia-related PCA were associated with improved survival.•It is extremely important to identify modifiable factors associated with PCA.