The incidence of postoperative cardiac arrest and pre-resuscitation factors associated with post- cardiopulmonary resuscitation mortality: a single-center study in Thailand
Keywords:
Cardiac arrest, Pre-resuscitation factor, Post CPR mortality, Postoperative cardiac arrest, SOS scoreAbstract
Background: The author aimed to determine the incidence of in-hospital postoperative cardiac arrest requiring cardiopulmonary resuscitation (CPR), postoperative CPR mortality and pre-resuscitation factors associated with post CPR mortality.
Method: A retrospective cohort study was conducted at King Chulalongkorn Memorial Hospital in Thailand from September 2018 through August 2020. A total of 34,590 adult patients underwent surgical procedures under anesthesia were recruited by electronic data recorded review. A subset of patients with postoperative CPR was collected for demographic data, comorbidities, ASA classification, operative time, functional class, types of surgery, postoperative complications, the number of deaths and survival, and SOS score at 4 hours preceding cardiac arrest.
Results: A total of 34,590 adult surgical patients were recruited. In-hospital postoperative cardiac arrest incidence was 12 patients per 10,000 surgeries and predominated in emergency operation (28 per 10,000 surgeries; P< 0.0001). Risk ratio of emergency operation resulted in postoperative CPR was 3.15 (95% CI 1.72-5.77; P<0.001). Postoperative cardiac arrest patients aged 64.07 ± 16.58. The BMI was 23.46 ± 5.83. Mostly they were in ASA category 3 (44.2%). Everyone had general anesthetic procedures. The most common comorbidity was hypertension. In-hospital postoperative CPR mortality was 62.8%. Factors possibly predisposed to it were functional class < 4 METS, colorectal surgery and SOS score at 4 hours prior to cardiac arrest of at least 8.
Conclusion: Incidence of in-hospital postoperative cardiac arrest and mortality after CPR in the study tended to be lower than that of previous studies. Emergency operations predisposed to cardiac arrest. SOS score was possibly valuable as a prognostication tool, ICU triage, as well as, a part of the early warning score to prevent the overwhelming crisis. Surveillance for patient’s deterioration, effective rapid response system, and comprehensive preoperative rehabilitation should be emphasized.
References
Panchal AR, Berg KM, Hirsch KG, Kudenchuk PJ, Del Rios M, Cabañas JG, et al. 2019 American Heart Association Focused Update on Advanced Cardiovascular Life Support: Use of Advanced Airways, Vasopressors, and Extracorporeal Cardiopulmonary Resuscitation During Cardiac Arrest: An Update to the American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care. Circulation. 2019;140(24):e881-e94.
Truhlář A, Deakin CD, Soar J, Khalifa GE, Alfonzo A, Bierens JJ, et al. European Resuscitation Council Guidelines for Resuscitation 2015: Section 4. Cardiac arrest in special circumstances. Resuscitation. 2015;95:148-201.
Chanthawong S, Chau-In W, Pipanmekaporn T, Chittawatanarat K, Kongsayreepong S, Rojanapithayakorn N. Incidence of Cardiac Arrest and Related Factors in a Multi-Center Thai University-Based Surgical Intensive Care Units Study (THAI-SICU Study). J Med Assoc Thai. 2016;99 Suppl 6:S91-s9.
Andersen LW, Holmberg MJ, Berg KM, Donnino MW, Granfeldt A. In-Hospital Cardiac Arrest: A Review. JAMA. 2019;321(12):1200-10.
Jansen JO, Cuthbertson BH. Detecting critical illness outside the ICU: the role of track and trigger systems. Curr Opin Crit Care. 2010;16(3):184-90.
Ratapum Champunot, Somboon Tansuphaswasdikul, Nataya Kamsawang, Panya Tuandoung, DuangratThimsri. Application of Search Out Severity (SOS) Score for Identification of Deteriorating Patients in General Wards. BUDDHACHINARAJ MEDICAL JOURNAL. 2016;33(3):313-25.
Pisitsak C, Champunot R, Morakul S. The role of the hospitalists in the workforce to address the shortages of intensivists in hospitals here in Thailand. J Med Assoc Thai. 2014;97 Suppl 1:S132-6.
Zuercher M, Ummenhofer W. Cardiac arrest during anesthesia. Curr Opin Crit Care. 2008;14(3):269-74.
Hinkelbein J, Andres J, Thies KC, E DER. Perioperative cardiac arrest in the operating room environment: a review of the literature. Minerva Anestesiol. 2017;83(11):1190-8.
Moitra VK, Gabrielli A, Maccioli GA, O’Connor MF. Anesthesia advanced circulatory life support. Can J Anaesth. 2012;59(6):586-603.
Bainbridge D, Martin J, Arango M, Cheng D. Perioperative and anaesthetic-related mortality in developed and developing countries: a systematic review and meta-analysis. Lancet. 2012;380(9847):1075-81.
Koga FA, El Dib R, Wakasugui W, Roça CT, Corrente JE, Braz MG, et al. Anesthesia-Related and Perioperative Cardiac Arrest in Low- and High-Income Countries: A Systematic Review With Meta-Regression and Proportional Meta-Analysis. Medicine (Baltimore). 2015;94(36):e1465.
Braghiroli KS, Braz JRC, Rocha B, El Dib R, Corrente JE, Braz MG, et al. Perioperative and anesthesia-related cardiac arrests in geriatric patients: a systematic review using meta-regression analysis. Sci Rep. 2017;7(1):2622.
Kazaure HS, Roman SA, Rosenthal RA, Sosa JA. Cardiac arrest among surgical patients: an analysis of incidence, patient characteristics, and outcomes in ACS-NSQIP. JAMA Surg. 2013;148(1):14-21.
Siriphuwanun V, Punjasawadwong Y, Lapisatepun W, Charuluxananan S, Uerpairojkit K. Incidence of and factors associated with perioperative cardiac arrest within 24 hours of anesthesia for emergency surgery. Risk Manag Healthc Policy. 2014;7:155-62.
Siriphuwanun V, Punjasawadwong Y, Saengyo S, Rerkasem K. Incidences and factors associated with perioperative cardiac arrest in trauma patients receiving anesthesia. Risk Manag Healthc Policy. 2018;11:177-87.
Kaiser HA, Saied NN, Kokoefer AS, Saffour L, Zoller JK, Helwani MA. Incidence and prediction of intraoperative and postoperative cardiac arrest requiring cardiopulmonary resuscitation and 30-day mortality in non-cardiac surgical patients. PLoS One. 2020;15(1):e0225939.
Braz LG, Módolo NS, do Nascimento P, Jr., Bruschi BA, Castiglia YM, Ganem EM, et al. Perioperative cardiac arrest: a study of 53,718 anaesthetics over 9 yr from a Brazilian teaching hospital. Br J Anaesth. 2006;96(5):569-75.
Ellis SJ, Newland MC, Simonson JA, Peters KR, Romberger DJ, Mercer DW, et al. Anesthesia-related cardiac arrest. Anesthesiology. 2014;120(4):829-38.
Siriphuwanun V, Punjasawadwong Y, Lapisatepun W, Charuluxananan S, Uerpairojkit K. Prognostic factors for death and survival with or without complications in cardiac arrest patients receiving CPR within 24 hours of anesthesia for emergency surgery. Risk Manag Healthc Policy. 2014;7:199-210.
Siracuse JJ, Meltzer EC, Gill HL, Graham AR, Schneider DB, Connolly PH, et al. Outcomes and risk factors of cardiac arrest after vascular surgery procedures. J Vasc Surg. 2015;61(1):197-202.
Vakil K, Kealhofer JV, Alraies MC, Garcia S, McFalls EO, Kelly RF, et al. Long-Term Outcomes of Patients Who Had Cardiac Arrest After Cardiac Operations. Ann Thorac Surg. 2016;102(2):512-7.
Newland MC, Ellis SJ, Lydiatt CA, Peters KR, Tinker JH, Romberger DJ, et al. Anesthetic-related cardiac arrest and its mortality: a report covering 72,959 anesthetics over 10 years from a US teaching hospital. Anesthesiology. 2002;97(1):108-15.
Krutsri C, Sumpritpradit P, Singhatas P, Thampongsa T, Phuwapraisirisan S, Gesprasert G, et al. Morbidity, mortality, and risk factors of emergency colorectal surgery among older patients in the Acute Care Surgery service: A retrospective study. Ann Med Surg (Lond). 2021;62:485-9.
Braz LG, Braz DG, Cruz DS, Fernandes LA, Módolo NS, Braz JR. Mortality in anesthesia: a systematic review. Clinics (Sao Paulo). 2009;64(10):999-1006.
Lienhart A, Auroy Y, Péquignot F, Benhamou D, Warszawski J, Bovet M, et al. Survey of anesthesia-related mortality in France. Anesthesiology. 2006;105(6):1087-97.
Tikkanen J, Hovi-Viander M. Death associated with anaesthesia and surgery in Finland in 1986 compared to 1975. Acta Anaesthesiol Scand. 1995;39(2):262-7.
