Unexpected cardiac arrest during anesthesia and surgery. An environmental study.

Medical and legal records of 41 cases of cardiac arrest that occurred during surgery were supplied by a professional liability insurance company and a review was undertaken in an attempt to identify recurring or common factors. The majority of patients in this study were healthy and required relatively routine elective surgical procedures. Only three of the patients survived the cardiac arrest and returned to normal activities. The remaining patients either died in the hospital or had a major central nervous system deficit. Hypoxia from hypoventilation and low levels of inspired oxygen appeared to be the chief cause of cardiac arrest in this study. Because of the unknown frequency of cardiac arrest during surgery, we recommend the establishment of a national registry of cardiac arrest cases that occur in surgical patients, in order to monitor incidence, causes, and outcome. Only in this way will it be possible to lessen the frequency of this disastrous event.