Frequency of anesthetic cardiac arrest and death in the operating room at a single general hospital over a 30-year period

Intraoperative and Anesthesia-Related Cardiac Arrest and Its Mortality in Older Patients: A 15-Year Survey in a Tertiary Teaching Hospital

“…It is difficult to compare the intraoperative CA and mortality rates in our study with the results of previous studies (Table 7) because of considerable differences in the methods and patient populations among studies [3], [5]–[10], [13]–[16]. There is no consensus in the literature regarding the definition of perioperative and anesthesia-related mortality [17].…”

The incidence and risk factors for cardiac arrest during emergency tracheal intubation: A justification for incorporating the ASA Guidelines in the remote location

“…The emergent nature of the airway intervention, the clinical disease state that prompted intubation, the hemodynamic impact from anesthetic medications, the initiation of positive-pressure ventilation (PPV), and any intervening airway-related complication contributing to profound hypoxemia may contribute to this event ( Table 9). [1][2][3][4][5] The underlying pathophysiology appears to be a major contributor to the risk of cardiac arrest, as is suggested in the group who arrested following a relatively uneventful intubation. There is no doubt that a relative anesthetic overdose can lead to cardiac collapse [two related to propofol (0.8 to 1.1 mg/kg, 100 to 150 mg)].…”

“…Furthermore, overzealous ventilation leading to a relative or absolute hypocarbic state in the previously hypercarbic patient, may further erode sympathetic tone ( Table 9). [4][5][6]8,23,24 Airway management difficulties, singly or in combination with other factors, added further to the rapid hemodynamic collapse in the majority of cases ( Table 9). In total, these factors appear to escalate the rate of cardiac arrest during emergency tracheal intubation outside the OR.…”

“…Airway management difficulties, however, contribute to a significant number of these anesthesia-related catastrophies. [1][2][3][4][5] Emergency airway management can be fraught with complications related to hemodynamic alterations and difficulty with oxygenation and ventilation. Esophageal intubation, pneumothorax, pulmonary aspiration, and death (2.6%), as well as other major complications, were reported by Schwartz et al 6 to occur relatively frequently.…”

“…[6][7][8] Intraoperative cardiac arrest is increased sixfold during emergency surgery compared with the elective setting, but, unfortunately, this fact does not provide a useful reference basis for comparison with emergency airway management outside the OR. [1][2][3][4][5] This quality improvement (QI) database was analyzed to determine the incidence and risk factors contributing to cardiac arrest during emergency tracheal intubation in the remote location. Moreover, two time periods were evaluated to determine whether the ASA Guidelines for Management of the Difficult Airway had any demonstrable effect on the rate of cardiac arrest by offering immediate access to endotracheal tube-verifying devices and advanced airway devices.…”