Diogo Sobreira-Fernandes1, Laetitia Teixeira2, Tiago S Lemos3, Liliana Costa3, Manuela Pereira3, António C Costa3, Paula S Couto3. 1. Department of Anesthesiology, Emergency and Intensive Care, Centro Hospitalar do Porto, Largo Abel Salazar, 4099-001 Porto, Portugal. Electronic address: sobreirafernandes@gmail.com. 2. Institute of Biomedical Science of Abel Salazar, Rua Jorge de Viterbo Ferreira 228, 4050-313 Porto, Portugal. 3. Department of Anesthesiology, Emergency and Intensive Care, Centro Hospitalar do Porto, Largo Abel Salazar, 4099-001 Porto, Portugal.
Abstract
STUDY OBJECTIVE: To determine the incidence, risk factors, and predictors of survival of perioperative cardiac arrests (PCAs) occurring in patients who underwent non-cardiac and non-obstetric surgery from January 2008 to May 2015 at a tertiary hospital; determine the incidence and risk factors of anesthesia-related PCA. DESIGN: Retrospective observational study. SETTING: Operating room and postoperative recovery area. PATIENTS: Sixty-two PCA cases from an anesthesia database of 122,289 anesthetics. INTERVENTIONS: Each PCA was classified as anesthesia-related, partially anesthesia-related, or anesthesia unrelated. The main outcome variables were occurrence of PCA, survival at least 1 h after initial resuscitation and survival to hospital discharge. To determine the risk factors for PCA, for each patient who suffered a PCA, two other patients that underwent anesthesia on the same day and in the same operating suite were selected. MEASUREMENTS: Three sets of variables were collected; patient-related, surgical procedure-related, and PCA-related. MAIN RESULTS: The incidence of PCAs of all causes was 5.07 per 10,000 anesthetics, and the associated mortality was 2.9 per 10,000 anesthetics. The independent risk factors for occurrence were: ASA PS score higher than 3, diagnosed cardiac disease, and the use of vasopressors. Decreased survival was associated with: higher ASA PS score, urgent surgical procedures of a higher complexity, use of vasopressors, documented hypotension prior to PCA, and arrests due to bleeding. The incidence of anesthesia-related PCAs was 0.74 per 10,000 anesthetics, and the associated mortality was 0.08 per 10,000 anesthetics. The main causes of anesthesia-related PCAs were associated with medication and airway/ventilation, and the independent risk factors for occurrence were: ASA PS score higher than 3 and diagnosed cardiac disease. CONCLUSIONS: Most PCAs were not due to anesthesia-related causes, and anesthesia-related PCAs were associated with improved survival. Improvements in the management of high-risk patients, medication administration, and airway/ventilation management may result in better outcomes.
STUDY OBJECTIVE: To determine the incidence, risk factors, and predictors of survival of perioperative cardiac arrests (PCAs) occurring in patients who underwent non-cardiac and non-obstetric surgery from January 2008 to May 2015 at a tertiary hospital; determine the incidence and risk factors of anesthesia-related PCA. DESIGN: Retrospective observational study. SETTING: Operating room and postoperative recovery area. PATIENTS: Sixty-two PCA cases from an anesthesia database of 122,289 anesthetics. INTERVENTIONS: Each PCA was classified as anesthesia-related, partially anesthesia-related, or anesthesia unrelated. The main outcome variables were occurrence of PCA, survival at least 1 h after initial resuscitation and survival to hospital discharge. To determine the risk factors for PCA, for each patient who suffered a PCA, two other patients that underwent anesthesia on the same day and in the same operating suite were selected. MEASUREMENTS: Three sets of variables were collected; patient-related, surgical procedure-related, and PCA-related. MAIN RESULTS: The incidence of PCAs of all causes was 5.07 per 10,000 anesthetics, and the associated mortality was 2.9 per 10,000 anesthetics. The independent risk factors for occurrence were: ASA PS score higher than 3, diagnosed cardiac disease, and the use of vasopressors. Decreased survival was associated with: higher ASA PS score, urgent surgical procedures of a higher complexity, use of vasopressors, documented hypotension prior to PCA, and arrests due to bleeding. The incidence of anesthesia-related PCAs was 0.74 per 10,000 anesthetics, and the associated mortality was 0.08 per 10,000 anesthetics. The main causes of anesthesia-related PCAs were associated with medication and airway/ventilation, and the independent risk factors for occurrence were: ASA PS score higher than 3 and diagnosed cardiac disease. CONCLUSIONS: Most PCAs were not due to anesthesia-related causes, and anesthesia-related PCAs were associated with improved survival. Improvements in the management of high-risk patients, medication administration, and airway/ventilation management may result in better outcomes.
Authors: Leandro Gobbo Braz; Arthur Caus de Morais; Rafael Sanchez; Daniela de Sá Menezes Porto; Mariana Pacchioni; Williany Dark Silva Serafim; Norma Sueli Pinheiro Módolo; Paulo do Nascimento Jr; Mariana Gobbo Braz; José Reinaldo Cerqueira Braz Journal: Braz J Anesthesiol Date: 2020-05-12