Intraoperative Cardiac Arrests in Adults Undergoing Noncardiac Surgery

Goswami, Sumeet; Brady, Joanne E.; Jordan, D. C.; Li, Guohua

doi:10.1097/aln.0b013e31827005e9

Cited by 93 publications

(97 citation statements)

References 29 publications

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“…Among the reduced morbidities seen with a restricted transfusion strategy were lower rates of re-bleeding, nosocomial infection, multi-organ failure, heart failure, myocardial infarction and mortality rates were reduced by about half [66]. In a recent study, Goswami et al [67] prospectively assessed the incidence, risk factors and survival outcome of intraoperative cardiac arrest in adult patients undergoing non-cardiac surgery utilizing the American College of Surgeons National Surgical database from the years 2005 to 2007 (n = 362,767). Intraoperative cardiac arrest was reported in 262 patients, with death rate of 44% within 24 h and 63% within 30 days.…”

Section: Conservative Blood Transfusionmentioning

confidence: 94%

“…Intraoperative cardiac arrest was reported in 262 patients, with death rate of 44% within 24 h and 63% within 30 days. Progressive increase in intra-operative cardiac arrest was associated with the amount of RBC transfusion (adjusted odds ratios: 2.51, 7.59, 11.40 and 29.68 for those receiving 1-3, 4-6, 7-9 and ‡10 units, respectively) [67].…”

Section: Conservative Blood Transfusionmentioning

confidence: 99%

See 1 more Smart Citation

Transfusion immunomodulation from a clinical perspective: an update

Refaai

Blumberg

2013

Expert Review of Hematology

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Accumulated evidence demonstrates that allogeneic blood transfusions have clinically significant effects on the recipient's immune system. This transfusion immunomodulation effect is associated with an increased rate of cancer recurrence (uncertain causality) and post-operative infection (established causality). The exact mechanisms of transfusion immunomodulation are still unknown. Data suggests that transfusion immunomodulation is a biologic effect strongly associated with the infusion of allogeneic leukocytes. Soluble mediators that accumulate in transfused red cells and platelets during storage are also possible causes of post-transfusion complications. Some approaches can mitigate these effects. Most important is adopting more conservative transfusion practices. Leukoreduction (proven) and plasma depletion (proposed) are other methods to significantly reduce transfusion immunomodulation and its clinical sequela.

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Section: Conservative Blood Transfusionmentioning

confidence: 94%

Section: Conservative Blood Transfusionmentioning

confidence: 99%

Transfusion immunomodulation from a clinical perspective: an update

Refaai

Blumberg

2013

Expert Review of Hematology

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“…Cardiac arrest in patients after receiving anesthesia for emergency surgery occurs at a rate of more than twice that of elective surgical cases, and also with significantly higher mortality rates 1–6. Two studies reported that 50%–60% of all episodes of cardiac arrest in surgical patients occurred in patients undergoing emergency surgeries 2,7.…”

Section: Introductionmentioning

confidence: 99%

“…Previous studies have revealed many factors, such as age,5,11 underlying conditions,1 American Society of Anesthesiologists (ASA) physical status classification,4,6,10 hemodynamic changes,12 blood loss,6 the anatomic site of the surgery,5,10 and the types and severity of injuries (for example: blunt trauma and vascular injuries)13,14 associated with cardiac arrest during anesthesia. Recognition of such risk factors may help anesthesia care providers to plan appropriate anesthetic care, including the preparation of resuscitation equipment and medications in order to deal promptly with cardiac arrest.…”

Section: Introductionmentioning

confidence: 99%

Incidence of and factors associated with perioperative cardiac arrest within 24 hours of anesthesia for emergency surgery

Siriphuwanun¹,

Punjasawadwong²,

Lapisatepun³

et al. 2014

RMHP

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PurposeTo determine the incidence of and factors associated with perioperative cardiac arrest within 24 hours of receiving anesthesia for emergency surgery.Patients and methodsThis retrospective cohort study was approved by the ethical committee of Maharaj Nakorn Chiang Mai Hospital, Thailand. We reviewed the data of 44,339 patients receiving anesthesia for emergency surgery during the period from January 1, 2003 to March 31, 2011. The data included patient characteristics, surgical procedures, American Society of Anesthesiologists (ASA) physical status classification, anesthesia information, location of anesthesia performed, and outcomes. Data of patients who had received topical anesthesia or monitoring anesthesia care were excluded. Factors associated with cardiac arrest were identified by univariate analyses. Multiple regressions for the risk ratio (RR) and 95% confidence intervals (CI) were used to determine the strength of factors associated with cardiac arrest. A forward stepwise algorithm was chosen at a P-value <0.05.ResultsThe incidence (within 24 hours) of perioperative cardiac arrest in patients receiving anesthesia for emergency surgery was 163 per 10,000. Factors associated with 24-hour perioperative cardiac arrest in emergency surgery were age of 2 years or younger (RR =1.46, CI =1.03–2.08, P=0.036), ASA physical status classification of 3–4 (RR =5.84, CI =4.20–8.12, P<0.001) and 5–6 (RR =33.98, CI =23.09–49.98, P<0.001), the anatomic site of surgery (upper intra-abdominal, RR =2.67, CI =2.14–3.33, P<0.001; intracranial, RR =1.74, CI =1.35–2.25, P<0.001; intrathoracic, RR =2.35, CI =1.70–3.24, P<0.001; cardiac, RR =3.61, CI =2.60–4.99, P<0.001; and major vascular; RR =3.05, CI =2.22–4.18, P<0.001), respiratory or cardiovascular comorbidities (RR =1.95, CI =1.60–2.38, P<0.001 and RR =1.38, CI =1.11–1.72, P=0.004, respectively), and patients in shock prior to receiving anesthesia (RR =2.62, CI =2.07–3.33, P<0.001).ConclusionThe perioperative incidence of cardiac arrest within 24 hours of anesthesia for emergency surgery was high and associated with multiple factors such as young age (≤2 years old), cardiovascular and respiratory comorbidities, increasing ASA physical status classification, preoperative shock, and surgery site. Perioperative care providers, including surgeons, anesthesiologists, and nurses, should be prepared to manage promptly this high risk group of surgical patients.

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“…3,7---11 These differences in incidence may vary greatly mainly because the studied period varies significantly from 2 to 10 years and there is a lack of adequate epidemiological recording. 12 The importance of the length of the study time is crucial, since improvements in technologies and in clinical practices may have impacted the study period. 13 Also, with the emphasis on patient safety in anesthesia since the early 1980s, and with more concentrated efforts toward patient safety since the 1990s, a reduction of the incidence of perioperative mortality was observed.…”

Section: Introductionmentioning

confidence: 99%