Anesthesia-related Cardiac Arrest

Anesthesiology (Impact Factor: 5.88). 02/2014; 120(4). DOI: 10.1097/ALN.0000000000000153
Source: PubMed


Much is still unknown about the actual incidence of anesthesia-related cardiac arrest in the United States.
The authors identified all of the cases of cardiac arrest from their quality improvement database from 1999 to 2009 and submitted them for review by an independent study commission to give them the best estimate of anesthesia-related cardiac arrest at their institution. One hundred sixty perioperative cardiac arrests within 24 h of surgery were identified from an anesthesia database of 217,365 anesthetics. An independent study commission reviewed all case abstracts to determine which cardiac arrests were anesthesia-attributable or anesthesia-contributory. Anesthesia-attributable cardiac arrests were those cases in which anesthesia was determined to be the primary cause of cardiac arrest. Anesthesia-contributory cardiac arrests were those cases where anesthesia was determined to have contributed to the cardiac arrest.
Fourteen cardiac arrests were anesthesia-attributable, resulting in an incidence of 0.6 per 10,000 anesthetics (95% CI, 0.4 to 1.1). Twenty-three cardiac arrests were found to be anesthesia-contributory resulting in an incidence of 1.1 per 10,000 anesthetics (95% CI, 0.7 to 1.6). Sixty-four percent of anesthesia-attributable cardiac arrests were caused by airway complications that occurred primarily with induction, emergence, or in the postanesthesia care unit, and mortality was 29%. Anesthesia-contributory cardiac arrest occurred during all phases of the anesthesia, and mortality was 70%.
As judged by an independent study commission, anesthesia-related cardiac arrest occurred in 37 of 160 cardiac arrests within the 24-h perioperative period.

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    ABSTRACT: Background Little information is known about factors that influence perioperative and anesthesia-related cardiac arrest (CA) in older patients. This study evaluated the incidence, causes and outcome of intraoperative and anesthesia-related CA in older patients in a Brazilian teaching hospital between 1996 and 2010. Methods During the study, older patients received 18,367 anesthetics. Data collected included patient characteristics, surgical procedures, American Society of Anesthesiologists (ASA) physical status, anesthesia type, medical specialty team and outcome. All CAs were categorized by cause into one of four groups: patient's disease/condition-related, surgery-related, totally anesthesia-related or partially anesthesia-related. Results All intraoperative CAs and deaths rates are shown per 10,000 anesthetics. There were 100 CAs (54.44; 95% confidence intervals [CI]: 44.68–64.20) and 68 deaths (37.02; 95% CI: 27.56–46.48). The majority of CAs were patient's disease-/condition-related (43.5; 95% CI: 13.44–73.68). There were six anesthesia-related CAs (3.26; 95% CI: 0.65–5.87) - 1 totally and 5 partially anesthesia-related, and three deaths, all partially anesthesia-related (1.63; 95% CI: 0.0–3.47). ASA I-II physical status patients presented no anesthesia-related CA. Anesthesia-related CA, absent in the last five years of the study, was due to medication-/airway-related causes. ASA physical status was the most important predictor of CA (odds ratio: 14.52; 95% CI: 4.48–47.08; P<0.001) followed by emergency surgery (odds ratio: 8.07; 95% CI: 5.14–12.68; P<0.001). Conclusions The study identified high incidence of intraoperative CAs with high mortality in older patients. The large majority of CAs were caused by factors not anesthesia-related. Anesthesia-related CA and mortality rates were 3.26 and 1.63 per 10,000 anesthetics, with no anesthesia-related CA in the last five years of the study. Major predictors of intraoperative CAs were poorer ASA physical status and emergency surgery. All anesthesia-related CAs were medication-related or airway-related, which is important for prevention strategies.
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    ABSTRACT: Background: Cardiac arrest is a rare but important event in the operating room and postanesthesia care unit, when surgical patients are most intensively monitored. Several recent publications have reported the rate of cardiac arrest in surgical patients during the subsequent hospital stay but have not uniquely identified the immediate perioperative period. We hypothesized that cardiac arrest during this time (intraprocedure and postanesthesia care) would occur at a lower frequency than that described for inpatient hospital care in the available literature. Methods: We extracted data from all cardiac arrests and immediate perioperative deaths reported to the National Anesthesia Clinical Outcomes Registry for the period from 2010 to 2013 and analyzed for anesthesia-related risk factors. We compared these data to published rates of in-hospital cardiac arrest after surgery. Results: Overall, the risk of cardiac arrest was 5.6 per 10,000 cases, which is less than in previous reports of in-hospital arrests in surgical patients overall, with an associated mortality from the arrest of 58.4%. The rate of cardiac arrest increased with age and ASA physical status. The rate of cardiac arrest was significantly higher for males, as was the mortality. Conclusions: The National Anesthesia Clinical Outcomes Registry is an emerging resource for examination of perioperative and anesthesia-related outcomes. Cardiac arrest is less frequent in the periprocedural setting than later in the hospital course, with most arrests predictably occurring in patients with ASA physical status III-V. The finding of increased risk of mortality in male patients cannot be readily explained and should prompt future research attention.
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    Full-text · Article · Feb 2015
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