Clinical practice recommendations on the management of perioperative cardiac arrest: A report from the PERIOPCA Consortium

Abstract

Background Perioperative cardiac arrest is a rare complication with an incidence of around 1 in 1400 cases, but it carries a high burden of mortality reaching up to 70% at 30 days. Despite its specificities, guidelines for treatment of perioperative cardiac arrest are lacking. Gathering the available literature may improve quality of care and outcome of patients. Methods The PERIOPCA Task Force identified major clinical questions about the management of perioperative cardiac arrest and framed them into the therapy population [P], intervention [I], comparator [C], and outcome [O] (PICO) format. Systematic searches of PubMed, Embase, and the Cochrane Library for articles published until September 2020 were performed. Consensus-based treatment recommendations were created using the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) system. The strength of consensus among the Task Force members about the recommendations was assessed through a modified Delphi consensus process. Results Twenty-two PICO questions were addressed, and the recommendations were validated in two Delphi rounds. A summary of evidence for each outcome is reported and accompanied by an overall assessment of the evidence to guide healthcare providers. Conclusions The main limitations of our work lie in the scarcity of good quality evidence on this topic. Still, these recommendations provide a basis for decision making, as well as a guide for future research on perioperative cardiac arrest.

Response to: In-hospital cardiac arrest: evidence and specificities of perioperative cardiac arrest

“…The epidemiology, treatment and outcome from perioperative cardiac arrest warrant a separate review—we certainly did not have enough space within our review to do justice to the topic. The clinical practice recommendations made by the Perioperative Cardiac Arrest (PERIOPCA) Consortium are potentially helpful [ 2 ], as are guidelines published previously by another international group [ 3 , 4 ]. Unfortunately, it is unlikely that we will ever have high-certainty evidence to inform clinical guidelines on the treatment of perioperative cardiac arrest.…”

“…Response to: In-hospital cardiac arrest: evidence and specificities of perioperative cardiac arrest James Penketh 1* and Jerry P. Nolan 1,2 Dear Editor,…”

In-hospital cardiac arrest: evidence and specificities of perioperative cardiac arrest

“…In order to provide a scientific background for decision-making, as well as a guide for future research on perioperative cardiac arrest, the PERIOPCA Consortium recently published for the first time a consensus on 22 PICO questions specially formulated for the perioperative setting [ 4 ]. These recommendations (Table 1 ) are strengthened by a strict methodology including a modified Delphi consensus-building strategy and can be used in clinical practice.…”

“…In-hospital cardiac arrest: evidence and specificities of perioperative cardiac arrest Quentin de Roux 1,2,3 , Athanasios Chalkias 4,5 , Theodoros Xanthos 6 and Nicolas Mongardon 1,2,3* To the Editor, We read with great interest the article by Penketh and Nolan, which provides a comprehensive overview on inhospital cardiac arrest (IHCA) [1]. We fully concur with the authors that guidelines for treatment of IHCA are lacking, and that several data are extrapolated from outof-hospital cardiac arrest literature.…”

Comments on ‘Cardiac arrest during the perioperative period’

“…Current knowledge, embodied by reviews and guidelines on IOCA in adult patients, consists of two review articles published in 2018, 2,3 and two guidelines -the European Resuscitation Council Guidelines (ERC) on cardiac arrest in special circumstances, published in 2021, 4 and Clinical Practice recommendations also published in 2021. 5 A common theme in these publications is the lack of strong evidence underpinning recommendations for clinical practice. One question that you need to address for your projected MMR is whether you limit the analysis of the way the IOCA was managed to the recent ESAIC/ ESTES Guidelines or whether you extend your efforts to these other articles cited previously.…”