Intra-operative cardiac arrest--a tropical experience

In order to determine the pattern of intra-operative cardiac arrests in a developing country, we reviewed 40 consecutives cases of cardiac arrests at the Jos University Teaching Hospital between January 1993 and December 1997. During this period 15,060 minor cases and 9800 medium/major surgical procedures were performed and an arrest rate of 1:15,060 for minor cases and 1:251 for medium/major cases were obtained. The age ranged between one day and 65 years with a mean of 29.8 years and a male/female ratio of 1:1.3 as there were 18 males and 22 females. Twenty-five (62.5%) arrests occurred outside work hours while fifteen (37.5%) cases arrested during work hours. The surgical procedures with high arrest rates in this study were: emergency laparotomy 8 (20%), emergency caesarian sections 7 (17.5%), thoracotomy 6(15%), emergency craniotomy 5(12.5%), emergency hysterectomy 4(10%) and therapeutic bronchoscopy for foreign bodies in the airway 4(10%). The arrests occurred in 30(75%) emergency procedures as opposed to 10(25%) elective cases. Only in 3 out of the 18, 318 day case procedures did the patients arrest. One patient arrested during local infiltration of lignocaine while the other 39(97.5%) arrested under general anaesthesia. There was no arrest with spinal anaesthesia. The predisposing factors for a patient to arrest on the operating table in our environment include emergency major surgery, poor risk patients with ASA 111 and above, surgery performed outside work hours, under general anaesthesia administered by nurse anaesthetists or junior anaesthetic residents. The success rate at resuscitation is highest with patients with ASA 1 & 11, operations performed during work hours and by senior surgeons and anaesthetists.