Predictors of Functional Outcome after Intraoperative Cardiac Arrest

Constant, Anne-Laure; Montlahuc, Claire; Grimaldi, David; Pichon, Nicolas; Bordenave, Lauriane; Soummer, Alexis; Sauneuf, Bertrand; Ricome, Sylvie; Misset, Benoît; Schnell, David; Dubuisson, Etienne; Brunet, Jennifer; Lasocki, Sigismond; Cronier, Pierrick; Bouhemad, Bélaïd; Loriferne, Jean-François; Bégot, Emmanuelle; Vandenbunder, Benoit; Dhonneur, Gilles; Bédos, Jean‐Pierre; Jullien, P.; Resche-Rigon, Matthieu; Legriel, Stéphane

doi:10.1097/aln.0000000000000313

Cited by 31 publications

(28 citation statements)

References 61 publications

(50 reference statements)

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“…Approximately, 26% of IOCA was attributed to the surgical operation. [22] The operation of heart and large vessels was accompanied with the highest incidence of cardiac arrest, followed by combined thoraco-abdominal operation, thoracotomy, laparotomy, craniotomy, spinal operation, and limbs operation. [23] On the basis of our data, intraoperative massive blood loss was the leading cause of IOCA (33.3%).…”

Section: Discussionmentioning

confidence: 99%

Intraoperative cardiac arrest

Han

Wang²,

Wang³

et al. 2017

Medicine

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Intraoperative cardiac arrest (IOCA) is a lethal complication of noncardiac surgery. According to several reports, immediate survival after IOCA is approximately 50%. In this study, a retrospective case analysis was performed to determine the incidence of IOCA, the potential causes of cardiac arrest, and the risk factors of no resuscitation in patients undergoing tumorous surgery.The medical records of surgery patients who experienced cardiac arrest during the intraoperative period between 2005 and 2014 were reviewed. The general conditions of the patients with IOCA were compared between the successfully resuscitated group and the unresuscitated group.Fifteen patients with IOCA among 142,853 patients undergoing tumorous surgery were reviewed during the study period. Immediate survival after IOCA was 60%. Hospital survival was 46.7%. The incidence of IOCA decreased during 2010 to 2014 when compared with the rate during 2005 to 2009 (P < .05). The risk factors affecting the success of resuscitation after IOCA included American Society of Anesthesiologists Physical Status (ASA PS) classification ≥ III (P < .05) and preoperative tachycardia (heart rate ≥100/min, P < .05). The methods of anesthesia had no effects on the results of resuscitation.The incidence of IOCA in patients undergoing tumorous surgery was 1.05 per 10,000 anesthesia. The overall mortality of IOCA was 0.56/10,000. The frequency of IOCA decreased within 10 years. There was no cardiac arrest primarily attributable to anesthesia over this study period. The risk factors leading to unsuccessful resuscitation after IOCA were ASA PS classification ≥ III and preoperative tachycardia.

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Section: Discussionmentioning

confidence: 99%

Intraoperative cardiac arrest

Han

Wang²,

Wang³

et al. 2017

Medicine

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“…We defined intra‐operative cardiac arrest as loss of detectable pulse requiring chest compressions and/or defibrillation during the intra‐operative period, defined as including only the time spent in the operating room . The time spent transporting the patient to the recovery area, in the recovery area and transporting the patient to the intensive care unit was not included in the intra‐operative period.…”

Section: Methodsmentioning

confidence: 99%

“…Causes of cardiac arrest were categorised by consensus between two of the authors (JM and YC) as follows: haemorrhagic shock; cardiogenic shock; and others. We defined neurologically intact survival as a survivor with a cerebral performance category score of 1 or 2 (alive with good cerebral performance or sufficient cerebral function for independent activities of daily life, with or without mild neurological or psychological deficits) . We obtained cerebral performance category scores from medical records, scored on the day of discharge from the hospital.…”

Section: Methodsmentioning

confidence: 99%

“…Cardiac arrest and concomitant cardiopulmonary resuscitation (CPR) in the operating room is unique, in that well‐trained medical personnel with appropriate treatment and monitoring devices are available immediately, a situation that is different from other in‐ and out‐of‐hospital cardiac arrest situations . In addition, intra‐operative haemorrhage has been reported to be the most important predictor of cardiac arrest in non‐cardiac surgical patients .…”

Section: Introductionmentioning

confidence: 99%

“…In addition, intra‐operative haemorrhage has been reported to be the most important predictor of cardiac arrest in non‐cardiac surgical patients . Following peri‐operative CPR, the 24‐h survival rate ranges from 32% to 56% , and the neurologically intact survival rate is reportedly 25% .…”

Section: Introductionmentioning

confidence: 99%

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Extracorporeal cardiopulmonary resuscitation in refractory intra‐operative cardiac arrest: an observational study of 12‐year outcomes in a single tertiary hospital

et al. 2018

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Refractory intra-operative cardiac arrest is a challenging issue for anaesthetists. In this study, we analysed the outcomes of adult patients who received extracorporeal cardiopulmonary resuscitation for refractory intraoperative cardiac arrest between 2005 and 2016, using data from our institutional extracorporeal membrane oxygenation registry. We defined refractory intra-operative cardiac arrest as the failure of a return of spontaneous circulation after 30 min of cardiopulmonary resuscitation. The primary outcome measure was neurologically intact survival with a cerebral performance category score of 1 or 2 at hospital discharge. Between 2005 and 2016, extracorporeal cardiopulmonary resuscitation was used to treat 23 patients who experienced refractory cardiac arrest in the operating room. The survival rates of neurologically-intact subjects were 9/23 (39%) and 6/23 (26%) at 24 h postoperatively and at hospital discharge, respectively. The main cause of refractory-intra-operative cardiac arrest was haemorrhagic shock in 13 out of 23 (57%) patients, and the neurologically-intact survival rate in these patients was 3/13 (23%) at discharge. Our study showed that approximately a quarter of patients with refractory intra-operative cardiac arrest caused by haemorrhage would receive survival benefit from extracorporeal cardiopulmonary resuscitation. Therefore, extracorporeal cardiopulmonary resuscitation may be a possible option in this clinically-challenging situation.

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Frailty and Outcomes Following Cardiopulmonary Resuscitation for Perioperative Cardiac Arrest

et al. 2023

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ImportanceFrailty is associated with mortality following surgery and cardiopulmonary resuscitation (CPR) for in-hospital cardiac arrest. Despite the growing focus on frailty as a basis for preoperative risk stratification and concern that CPR in patients with frailty may border on futility, the association between frailty and outcomes following perioperative CPR is unknown.ObjectiveTo determine the association between frailty and outcomes following perioperative CPR.Design, Setting, and ParticipantsThis longitudinal cohort study of patients used the American College of Surgeons National Surgical Quality Improvement Program, including more than 700 participating hospitals in the US, from January 1, 2015, through December 31, 2020. Follow-up duration was 30 days. Patients 50 years or older undergoing noncardiac surgery who received CPR on postoperative day 0 were included; patients were excluded if data required to determine frailty, establish outcome, or perform multivariable analyses were missing. Data were analyzed from September 1, 2022, through January 30, 2023.ExposuresFrailty defined as Risk Analysis Index (RAI) of 40 or greater vs less than 40.Outcomes and MeasuresThirty-day mortality and nonhome discharge.ResultsAmong the 3149 patients included in the analysis, the median age was 71 (IQR, 63-79) years, 1709 (55.9%) were men, and 2117 (69.2%) were White. Mean (SD) RAI was 37.73 (6.18), and 792 patients (25.9%) had an RAI of 40 or greater, of whom 534 (67.4%) died within 30 days of surgery. Multivariable logistic regression adjusting for race, American Society of Anesthesiologists physical status, sepsis, and emergency surgery demonstrated a positive association between frailty and mortality (adjusted odds ratio [AOR], 1.35 [95% CI, 1.11-1.65]; P = .003). Spline regression analysis demonstrated steadily increasing probability of mortality and nonhome discharge with increasing RAI above 37 and 36, respectively. Association between frailty and mortality following CPR varied by procedure urgency (AOR for nonemergent procedures, 1.55 [95% CI, 1.23-1.97]; AOR for emergent procedures, 0.97 [95% CI, 0.68-1.37]; P = .03 for interaction). An RAI of 40 or greater was associated with increased odds of nonhome discharge compared with an RAI of less than 40 (AOR, 1.85 [95% CI, 1.31-2.62]; P &lt; .001).Conclusions and RelevanceThe findings of this cohort study suggest that although roughly 1 in 3 patients with an RAI of 40 or greater survived at least 30 days following perioperative CPR, higher frailty burden was associated with increased mortality and greater risk of nonhome discharge among survivors. Identifying patients who are undergoing surgery and have frailty may inform primary prevention strategies, guide shared decision-making regarding perioperative CPR, and promote goal-concordant surgical care.

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Predictors of Functional Outcome after Intraoperative Cardiac Arrest

Abstract: By day 90, 45% of IOCA survivors had good functional outcomes. The main outcome predictors were directly related to IOCA occurrence and postcardiac arrest syndrome; they suggest that the intensive care unit management of postcardiac arrest syndrome may be amenable to improvement.

Cited by 31 publications

References 61 publications

Intraoperative cardiac arrest

Intraoperative cardiac arrest

Extracorporeal cardiopulmonary resuscitation in refractory intra‐operative cardiac arrest: an observational study of 12‐year outcomes in a single tertiary hospital

Frailty and Outcomes Following Cardiopulmonary Resuscitation for Perioperative Cardiac Arrest

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