Cardiac Arrest Among Surgical Patients

Kazaure, Hadiza S.; Roman, Sanziana A.; Rosenthal, Ronnie A.; Sosa, Julie Ann

doi:10.1001/jamasurg.2013.671

Cited by 87 publications

(63 citation statements)

References 30 publications

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“…Compared to other studies during earlier periods, the rate of perioperative CPR and mortality according to the NSQIP database appears to have decreased. [2,9] However, the data on intraoperative CPR was not recorded within the database after 2012 limiting us of pursuing the trend during the subsequent years.…”

Section: Discussionmentioning

confidence: 99%

“…[2] Among these patients, three-quarters suffered from a postoperative complication before or on the day of CPR, and more than two thirds of them died in the first 30 days after surgery. [2] Every incident of cardiac arrest requiring CPR is not only harmful to the patient, but it is also taxing on the hospital staff, the patients' families, and adds additional financial burden to the health care system. For aforesaid reasons, identifying and reducing patient-specific risk factors is imperative to improve both patient safety and hospital cost.…”

Section: Introductionmentioning

confidence: 99%

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Incidence and prediction of intraoperative and postoperative cardiac arrest requiring cardiopulmonary resuscitation and 30-day mortality in non-cardiac surgical patients

Kaiser

Saied²,

Kokoefer

et al. 2020

PLoS ONE

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Background The incidence, prediction and mortality outcomes of intraoperative and postoperative cardiac arrest requiring cardiopulmonary resuscitation (CPR) in surgical patients are under investigated and have not been studied concurrently in a single study. Methods A retrospective cohort study was conducted using the American College of Surgeons National Surgical Quality Improvement Program data between 2008 and 2012. Firth's penalized logistic regression was used to study the incidence and identify risk factors for intraand postoperative CPR and 30-day mortality. simplified prediction model was constructed and internally validated to predict the studied outcomes. Results Among about 1.86 million non-cardiac operations, the incidence rate of intraoperative CPR was 0.03%, and for postoperative CPR was 0.33%. The 30-day mortality incidence rate was 1.25%. The incidence rate of events decreased overtime between 2008-2012. Of the 29 potential predictors, 14 were significant for intraoperative CPR, 23 for postoperative CPR, and 25 for 30-day mortality. The five strongest predictors (highest odd ratios) of intraoperative CPR were the American Society of Anesthesiologists (ASA) physical status, Systemic Inflammatory Response Syndrome (SIRS)/sepsis, surgery type, urgent/emergency case and anesthesia technique. Intraoperative CPR, ASA, age, functional status and end stage renal disease were the most significant predictors for postoperative CPR. The most significant predictors of 30-day mortality were ASA, age, functional status, SIRS/sepsis, and disseminated cancer. The predictions with the simplified five-factor model performed well and

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Incidence and prediction of intraoperative and postoperative cardiac arrest requiring cardiopulmonary resuscitation and 30-day mortality in non-cardiac surgical patients

Kaiser

Saied²,

Kokoefer

et al. 2020

PLoS ONE

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“…Not surprisingly, average length of hospitalization is longest for each of these diagnoses. 20–24 In 2009–2010, the average length of hospitalization for septicemia, cancer, and kidney disease was 9.3 days, 6.4 days, and 6.2 days, respectively, for the age group of 65–74 years. 25 The worst survival outcome in our cohort is found in the group with the longest hospitalization prior to the arrest which likely has a higher population of patients with these co-morbidities.…”

Section: Discussionmentioning

confidence: 99%

Frequency and survival pattern of in-hospital cardiac arrests: The impacts of etiology and timing

et al. 2016

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Objective Define the frequency and survival pattern of cardiac arrests in relation to the hospital day of event and etiology of arrest. Subject and methods Retrospective cohort study of adult in-hospital cardiac arrests between July 1, 2005, and June 30, 2013, that were classified by etiology of deterioration. Arrests were divided based on hospital day (HD) of event (HD1, HD2–7, HD>7 days), and analysis of frequency was performed. The primary outcome of survival to discharge and secondary outcomes of return of spontaneous circulation (ROSC) and favorable neurological outcomes were compared using multivariable logistic regression analysis. Results A total of 627 cases were included, 193 (30.8%) cases in group HD1, 206 (32.9%) in HD2–7, and 228 (36.4%) in HD>7. Etiology of arrest demonstrated variability across the groups (p < 0.001). Arrests due to ventilation issues increased in frequency with longer hospitalization (p < 0.001) while arrests due to dysrhythmia had the opposite trend (p = 0.014). Rates of survival to discharge (p = 0.038) and favorable neurological outcomes (p = 0.002) were lower with increasing hospital days while ROSC was not different among the groups (p = 0.183). Survival was highest for HD1 (HD1: 38.9% [95% CI, 32.0–45.7%], p = 0.002 vs HD2–7: 34.0% [95% CI, 27.5–40.4%], p < 0.001 vs HD>7: 27.2% [95% CI, 21.4–33.0%], p < 0.001). Conclusions The etiology of cardiac arrests varies in frequency as length of hospitalization increases. Survival rates and favorable neurological outcomes are lower for in-hospital arrests occurring later in the hospitalization, even when adjusted for age, sex, and location of event. Understanding these issues may help with focusing therapies and accurate prognostication.

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“…This upward trend in rates of hospital survival coincides with similar increases reported in the general population over this time frame, which has been attributed in part to advancements in resuscitation care. 8,20 This increase might also be a reflection of concurrent changes in hospital discharge practices reported in the general and wider Medicare populations and increasing use of hospice and long-term care facilities following an episode of in-hospital CPR where patients might subsequently die. 2,17 It seems less likely that improvements in survival to discharge may reflect more selective use of CPR in this population given the upward trend in the incidence of CPR and the proportion of in-hospital deaths preceded by CPR during the same time frame.…”

Section: Discussionmentioning

confidence: 99%

Trends in In-Hospital Cardiopulmonary Resuscitation and Survival in Adults Receiving Maintenance Dialysis

et al. 2015

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resuscitation (CPR) practices and outcomes can help to support advance care planning in patients receiving maintenance dialysis. OBJECTIVE To characterize patterns and outcomes of in-hospital CPR in US adults receiving maintenance dialysis. DESIGN, SETTING, AND PARTICIPANTS This national retrospective cohort study studied 663 734 Medicare beneficiaries 18 years or older from a comprehensive national registry for end-stage renal disease who initiated maintenance dialysis from January 1, 2000, through December 31, 2010. EXPOSURES Receipt of in-hospital CPR from 91 days after dialysis initiation through the time of death, first kidney transplantation, or end of follow-up on December 31, 2011. MAIN OUTCOMES AND MEASURES Incidence of CPR and survival after the first episode of CPR recorded in Medicare claims during follow-up. RESULTSThe annual incidence of CPR for the overall cohort was 1.4 events per 1000 in-hospital days (95% CI, 1.3-1.4). A total of 21.9% CPR recipients (95% CI, 21.4%-22.3%) survived to hospital discharge, with a median postdischarge survival of 5.0 months (interquartile range, 0.7-16.8 months). Among patients who died in the hospital, 14.9% (95% CI, 14.8%-15.1%) received CPR during their terminal admission. From 2000 to 2011, there was an increase in the incidence of CPR (1.0 events per 1000 in-hospital days; 95% CI, 0.9-1.1; to 1.6 events per 1000 in-hospital days; 95% CI, 1.6-1.7; P for trend <.001), the proportion of CPR recipients who survived to discharge (15.2%; 95% CI, 11.1%-20.5%; to 28%; 95% CI, 26.7%-29.4%; P for trend <.001), and the proportion of in-hospital deaths preceded by CPR (9.5%; 95% CI, 8.4%-10.8%; to 19.8%; 95% CI, 19.2%-20.4%; P for trend <.001), with no substantial change in duration of postdischarge survival.CONCLUSIONS AND RELEVANCE Among a national cohort of patients receiving maintenance dialysis, the incidence of CPR was higher and long-term survival worse than reported for other populations.

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Cardiac Arrest Among Surgical Patients

Cited by 87 publications

References 30 publications

Incidence and prediction of intraoperative and postoperative cardiac arrest requiring cardiopulmonary resuscitation and 30-day mortality in non-cardiac surgical patients

Incidence and prediction of intraoperative and postoperative cardiac arrest requiring cardiopulmonary resuscitation and 30-day mortality in non-cardiac surgical patients

Frequency and survival pattern of in-hospital cardiac arrests: The impacts of etiology and timing

Trends in In-Hospital Cardiopulmonary Resuscitation and Survival in Adults Receiving Maintenance Dialysis

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