Postoperative cardiac arrest after cardiac surgery: Can we improve our rescue rate?

Despite improvements in rescue strategies, postoperative cardiac arrest in adults undergoing cardiac surgery has not been examined in the contemporary era. This study assesses the incidence, outcomes, and predictors of survival in patients who had an in-hospital cardiac arrest after cardiac surgery.

Adult patients with cardiac arrest after open surgery from January 2012 to May 2019 at a single institution were studied. Patients were excluded if they underwent heart transplantation or left ventricular assist device implantation, experienced preoperative or intraoperative cardiac arrest, received preoperative or intraoperative temporary mechanical circulatory support, or were deemed as do not resuscitate or care was withdrawn before the arrest.

Of 9946 patients, 162 (1.6%) experienced a postoperative arrest with failure to rescue in 59 patients (36.4%). The etiology of cardiac arrest was cardiovascular in 101 patients (62.3%), respiratory in 27 patients (16.7%), metabolic in 15 patients (9.3%), other in 12 patients (7.4%), and unknown in 7 patients (4.3%). Thirteen patients (8.0%) were placed on extracorporeal membrane oxygenation postarrest with only 4 (30.8%) surviving to discharge. Patients were more likely to die in-hospital if they had postoperative, prearrest organ dysfunction (adjusted odds ratio, 7.08, 95% CI, 2.92-17.16).

Although the incidence of cardiac arrest was low, more than one-third of patients failed to be rescued. Prearrest major organ dysfunction portended a significantly worse prognosis. Early recognition of a nonthriving patient and rapid escalation of specialized care may be critical in successful rescue from cardiac arrest and aborting catastrophic outcomes.