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

Abstract

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

Association between intra‐operative cardiac arrest and country Human Development Index status: a systematic review with meta‐regression analysis and meta‐analysis of observational studies*

“…Comorbid conditions are potentially major contributors to the ongoing high rates of intra‐operative cardiac arrest in low‐HDI countries over time. As described in our review and in other studies, a poor ASA physical status (3–5) is an important predictor of intra‐operative and anaesthesia‐related cardiac arrest events [3, 27–30]. Thus, the pre‐anaesthetic management of comorbidities plays a major role in minimising intra‐operative complications and adverse effects [26, 31–34].…”

“…The presence of SIRS/sepsis has been associated with high mortality rates [36, 37]. A recent study in a high‐HDI country revealed that baseline ASA 4–5 physical status and SIRS/sepsis were the most important risk‐factors for intra‐operative cardiac arrest and death [3]. The rate of peri‐operative cardiac arrest related to SIRS/sepsis is five‐fold higher in low‐HDI countries than in high‐HDI countries [26, 38, 39].…”

Kreislaufstillstand unter besonderen Umständen

“…Starke Prädiktoren für den intraoperativen Kreislaufstillstand (IOCA) sind eine höhere Klassifikation der American Society of Anesthesiologists (ASA), akute Sepsis, Notfall‑/Akutfall, Anästhesietechnik und Alter [ 395 , 398 ]. Darüber hinaus gibt es verschiedene Faktoren wie Hypoxie, akuter Blutverlust mit Schock, Lungenembolie, Myokardinfarkt, Arrhythmie oder Elektrolytstörungen, die Ursache für einen intraoperativen Kreislaufstillstand sein oder dazu beitragen können [ 395 , 399 , 400 ].…”

Clinical practice recommendations on the management of perioperative cardiac arrest: A report from the PERIOPCA Consortium

“…Although PERIOPCA is usually witnessed, with onset under monitoring in face of healthcare professionals and immediate availability of therapeutic means, aggressive cardiopulmonary resuscitation (CPR) does not always lead to return of spontaneous circulation (ROSC) and optimal long-term outcomes, with 55% of the survivors having poor neurological status [6,7]. The precipitating causes of PERIOPCA are usually known, but these patients constitute an heterogeneous group and their management often requires modification of traditional CPR algorithms [8]. The heterogeneous nature of PERI-OPCA is further demonstrated by the differences in survival between intraoperative and postoperative CPR [8].…”

“…The precipitating causes of PERIOPCA are usually known, but these patients constitute an heterogeneous group and their management often requires modification of traditional CPR algorithms [8]. The heterogeneous nature of PERI-OPCA is further demonstrated by the differences in survival between intraoperative and postoperative CPR [8]. Indeed, coagulation and hemostasis disturbances may be a perceived as a potential barrier to controlled hypothermia.…”