Perioperative cardiac arrests - A subanalysis of the anesthesia -related cardiac arrests and associated mortality
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Published on: August 30, 2011
Diogo Sobreira-Fernandes1, Laetitia Teixeira2, Tiago S Lemos1
1Department of Anesthesiology, Emergency and Intensive Care, Centro Hospitalar do Porto, Largo Abel Salazar, 4099-001 Porto, Portugal.
Study Objective:
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.
Design:
Retrospective observational study.
Setting:
Operating room and postoperative recovery area.
Patients:
Sixty-two PCA cases from an anesthesia database of 122,289 anesthetics.
Interventions:
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.
Measurements:
Three sets of variables were collected; patient-related, surgical procedure-related, and PCA-related.
Main Results:
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.
Conclusions:
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.
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