Incidence of and factors associated with perioperative cardiac arrest within 24 hours of anesthesia for emergency surgery

Abstract

PurposeTo determine the incidence of and factors associated with perioperative cardiac arrest within 24 hours of receiving anesthesia for emergency surgery.Patients and methodsThis retrospective cohort study was approved by the ethical committee of Maharaj Nakorn Chiang Mai Hospital, Thailand. We reviewed the data of 44,339 patients receiving anesthesia for emergency surgery during the period from January 1, 2003 to March 31, 2011. The data included patient characteristics, surgical procedures, American Society of Anesthesiologists (ASA) physical status classification, anesthesia information, location of anesthesia performed, and outcomes. Data of patients who had received topical anesthesia or monitoring anesthesia care were excluded. Factors associated with cardiac arrest were identified by univariate analyses. Multiple regressions for the risk ratio (RR) and 95% confidence intervals (CI) were used to determine the strength of factors associated with cardiac arrest. A forward stepwise algorithm was chosen at a P-value <0.05.ResultsThe incidence (within 24 hours) of perioperative cardiac arrest in patients receiving anesthesia for emergency surgery was 163 per 10,000. Factors associated with 24-hour perioperative cardiac arrest in emergency surgery were age of 2 years or younger (RR =1.46, CI =1.03–2.08, P=0.036), ASA physical status classification of 3–4 (RR =5.84, CI =4.20–8.12, P<0.001) and 5–6 (RR =33.98, CI =23.09–49.98, P<0.001), the anatomic site of surgery (upper intra-abdominal, RR =2.67, CI =2.14–3.33, P<0.001; intracranial, RR =1.74, CI =1.35–2.25, P<0.001; intrathoracic, RR =2.35, CI =1.70–3.24, P<0.001; cardiac, RR =3.61, CI =2.60–4.99, P<0.001; and major vascular; RR =3.05, CI =2.22–4.18, P<0.001), respiratory or cardiovascular comorbidities (RR =1.95, CI =1.60–2.38, P<0.001 and RR =1.38, CI =1.11–1.72, P=0.004, respectively), and patients in shock prior to receiving anesthesia (RR =2.62, CI =2.07–3.33, P<0.001).ConclusionThe perioperative incidence of cardiac arrest within 24 hours of anesthesia for emergency surgery was high and associated with multiple factors such as young age (≤2 years old), cardiovascular and respiratory comorbidities, increasing ASA physical status classification, preoperative shock, and surgery site. Perioperative care providers, including surgeons, anesthesiologists, and nurses, should be prepared to manage promptly this high risk group of surgical patients.

Prognostic factors for death and survival with or without complications in cardiac arrest patients receiving CPR within 24 hours of anesthesia for emergency surgery

“…This was consistent with other studies which reported that patients in shock after accidents had a poor outcome after CPR 15,19,21. This is strongly supported by a study carried out at a university hospital in Thailand, which found that patients in shock undergoing anesthesia had high complications 28,46…”

“…This was confirmed by many studies conducted in Spain,15 Brazil,1 and Germany,21 while case reports from Australia19 added that patients with abdominal injuries and shock had a poor outcome after CPR. This finding is strongly supported by a study in a university hospital in Thailand, which found that abdominal surgery patients had a high cardiac arrest rate46 and also had high levels of post-CPR complications 28…”

Incidences and factors associated with perioperative cardiac arrest in trauma patients receiving anesthesia

“…The number of trauma patients receiving anesthesia for emergency surgery is higher in developing countries than in developed countries. 1 – 4 These patients have increased risk of intraoperative cardiac arrest, 2 , 4 – 6 over two times higher than that in elective surgical patients with high mortality rates. 4 , 5 , 7 – 12 Studies conducted in countries, in the past decade, such as Brazil showed that more than 50% of all incidences of perioperative cardiac arrest in surgical patients occurred in trauma patients receiving emergency surgeries.…”

“… 5 , 11 , 13 – 16 In Asian countries, incidences of all perioperative cardiac arrest vary in the range of 3–40 per 10,000; 17 – 20 there is an increase in the number of emergency surgeries compared to the number of incidences varying in the range of 7–160 per 10,000, and it is very high in trauma patients who experienced traffic accidents. 2 , 18 It was reported that in northern Thailand, among patients who underwent emergency surgery, there were high incidence rates of cardiac arrest within 24 hours of anesthesia and that these rates were higher than those in other Thailand regions and other countries. 2 …”

“… 2 , 18 It was reported that in northern Thailand, among patients who underwent emergency surgery, there were high incidence rates of cardiac arrest within 24 hours of anesthesia and that these rates were higher than those in other Thailand regions and other countries. 2 …”