Intraoperative Cardiac Arrests in Adults Undergoing Noncardiac Surgery Incidence, Risk Factors, and Survival Outcome

* Assistant Professor of Anesthesiology, † Senior Staff Associate, ‡ Associate Professor of Clinical Anesthesiology, Divisions of Cardiothoracic Anesthesiology & Critical Care Medicine, Department of Anesthesiology, College of Physicians and Surgeons, Columbia University, New York, New York. § Professor of Epidemiology and Director of the Center for Health Policy and Outcomes in Anesthesia and Critical Care, Department of Anesthesiology, College of Physicians and Surgeons, and Department of Epidemiology, Mailman School of Public Health, Columbia University.
Anesthesiology (Impact Factor: 6.17). 10/2012; 117(5):1018-1026. DOI: 10.1097/ALN.0b013e31827005e9
Source: PubMed

ABSTRACT BACKGROUND:: Intraoperative cardiac arrest (ICA) is a rare but potentially catastrophic event. There is a paucity of recent epidemiological data on the incidence and risk factors for ICA. The objective of this study was to assess the incidence, risk factors, and survival outcome of ICAs in adults undergoing noncardiac surgery. METHODS:: The authors analyzed prospectively collected data for all noncardiac cases in the American College of Surgeons National Surgical Quality Improvement Program database from the years 2005 to 2007 (n = 362,767). RESULTS:: The incidence of ICA was 7.22 per 10,000 surgeries. After adjustment for American Society of Anesthesiologists physical status and other covariates, the odds of ICA increased progressively with the amount of transfusion (adjusted odds ratios = 2.51, 7.59, 11.40, and 29.68 for those receiving 1-3, 4-6, 7-9, and ≥ 10 units of erythrocytes, respectively). Other significant risk factors for ICA were emergency surgery (adjusted odds ratio = 2.04, 95% CI = 1.45-2.86) and being functionally dependent presurgery (adjusted odds ratio = 2.33, 95% CI = 1.69-3.22). Of the 262 patients with ICA, 116 (44.3%) died within 24 h, and 164 (62.6%) died within 30 days. CONCLUSIONS:: Intraoperative blood loss as indicated by the amount of transfusion was the most important predictor of ICA. The urgency of surgery and the preoperative composite indicators of health such as American Society of Anesthesiologists status and functional status were other important risk factors. The high case fatality suggests that primary prevention might be the key to reducing mortality from ICA.

Download full-text


Available from: Guohua Li, Apr 28, 2014
  • [Show abstract] [Hide abstract]
    ABSTRACT: Im OP kann der Anästhesist jederzeit einen Palliativpatienten zu versorgen haben, wenn eine Operation oder andere Intervention, abhängig vom Krankheitsstadium, notwendig geworden ist. In der präoperativen Phase besteht die erste Herausforderung für den Anästhesisten darin, einen Palliativpatienten als solchen zu erkennen. Im Rahmen der Behandlung sind die bei dieser Patientengruppe bekannten Problemfelder zu berücksichtigen. Dazu gehören medizinisch die Symptomkontrolle und der Umgang mit Vormedikationen. Psychosozial sind gute kommunikative Fähigkeiten, insbesondere im Rahmen des Prämedikationsgesprächs, erforderlich. Ethisch können Konflikte bei der operativen Indikationsstellung und im Umgang mit vorbestehenden Therapielimitierungen bestehen. Zu diesen Problemen nimmt der vorliegende Beitrag Stellung. Er soll Denkanstöße liefern und dazu beitragen, dass diese vulnerable Patientengruppe die optimale perioperative Betreuung erhält mit dem Ziel, die postoperative Erholung schnellstmöglich herbeizuführen und somit die Lebensqualität zu erhalten bzw. zu verbessern.
    Der Anaesthesist 08/2013; 62(8). DOI:10.1007/s00101-013-2198-2 · 0.74 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: Perioperative safety concerns are a major area of interest in recent years. Severe cardiac perturbation such as cardiac arrest is one of the most dreaded complications in the intraoperative period; however, little is known about the management of these events in the patients undergoing elective neurosurgery. This special group needs further attention, as it is often neither feasible nor appropriate to apply conventional advanced cardiac life support algorithms in patients undergoing neurosurgery. Factors such as neurosurgical procedure and positioning can also have a significant effect on the occurrence of cardiac arrest. Therefore, the aim of this paper is to describe the various causes and management of cardiac emergencies with special reference to cardiac arrest during elective neurosurgical procedures, including discussion of position-related factors and resuscitative considerations in these situations. This will help to formulate possible guidelines for management of such events.
    BioMed Research International 01/2015; 2015:751320. DOI:10.1155/2015/751320 · 2.71 Impact Factor
  • Anesthesiology 10/2012; 117(5):948-50. DOI:10.1097/ALN.0b013e318270091b · 6.17 Impact Factor