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Published on: March 27, 2018
Analysis of cardiac arrest after coronary artery bypass grafting
Tengjiao Yang1, Xieraili Tiemuerniyazi1, Zhan Hu1
1Department of Cardiovascular Surgery, National Center for Cardiovascular Disease and Fuwai Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, 167 Beilishi Road, Xicheng, Beijing, 100037, People's Republic of China.
Insights
Cardiac arrest after coronary artery bypass grafting (CABG) is rare but serious. Patients experiencing cardiac arrest in general wards have a worse prognosis than those in intensive care units (ICUs), especially with non-shockable rhythms.
Area of Science:
- Cardiology
- Critical Care Medicine
- Cardiac Surgery
Background:
- Cardiac arrest following coronary artery bypass grafting (CABG) presents a significant challenge with limited survival rates.
- Prognosis is poorer for patients experiencing cardiac arrest in general wards compared to intensive care units (ICUs) due to delayed interventions.
Purpose of the Study:
- To compare cardiac arrest incidence and outcomes between ICUs and general wards post-CABG.
- To analyze survival differences based on cardiac arrest rhythm (shockable vs. non-shockable).
- To propose a management protocol for cardiac arrest in general ward settings.
Main Methods:
- Retrospective analysis of 41,450 patients undergoing CABG between January 2010 and December 2019.
- Comparison of cardiac arrest characteristics and outcomes in ICUs versus general wards.
- Stratification of patients into shockable and non-shockable rhythm groups for survival analysis.
Main Results:
- Cardiac arrest occurred in 0.56% (231/41,450) of post-CABG patients, with 46 occurring in general wards.
- General ward cardiac arrest patients had a 76.1% rescue success and 58.7% 30-day survival rate.
- Non-shockable rhythms were more frequent in general wards, associated with significantly worse 30-day survival (31.8%) compared to shockable rhythms (83.3%).
Conclusions:
- Cardiac arrest post-CABG is infrequent, but general ward occurrences indicate a poorer prognosis.
- Higher incidence of non-shockable rhythms in general wards contributes to worse early outcomes.
- Improved management protocols are needed for general ward cardiac arrest patients post-CABG.
Background:
Cardiac arrest after coronary artery bypass grafting (CABG) is a serious complication with low survival rate. The prognosis of patients with cardiac arrest in the general ward is worse than that in the intensive care unit (ICU) because of the delayed and poor rescue conditions.
Methods:
This retrospective study included patients who experienced cardiac arrest after CABG surgery between January 2010 and December 2019 at the Fuwai Hospital. Differences in cardiac arrest between the ICU and the general ward were compared. The patients were divided into shockable and non-shockable rhythm groups, and the differences between the two groups were compared. Finally, we proposed a management protocol for cardiac arrest in the general ward.
Results:
We retrospectively analyzed 41,450 patients who underwent CABG only, of whom 231 (0.56%) experienced cardiac arrest post-surgery in the ICU (185/231) or in the general ward (46/231). The rescue success rate and 30-day survival rate of the patients with cardiac arrest in the general ward were 76.1% (35/46) and 58.7% (27/46), respectively. The incidence of the different arrhythmia types of cardiac arrest in the general ward compared with that in the ICU was different (P = 0.010). The 30-day survival rate of the non-shockable rhythm group was 31.8% (7/22), which was worse than that of the shockable rhythm group (83.3% [20/24]; P = 0.001). Kaplan-Meier survival analysis showed that the prognosis of the non-shockable group was poor (P < 0.001).
Conclusions:
The incidence of cardiac arrest after CABG was low. The prognosis of patients in the general ward was worse than that of those in the ICU. The proportion of non-shockable rhythm type cardiac arrest was higher in the general ward than in the ICU, and patients in this group had a worse early prognosis.
