Methods of the 7^th National Audit Project (NAP7) of the Royal College of Anaesthetists: peri‐operative cardiac arrest

Abstract

Cardiac arrest in the peri-operative period is rare but associated with significant morbidity and mortality. Current reporting systems do not capture many such events, so there is an incomplete understanding of incidence and outcomes. As peri-operative cardiac arrest is rare, many hospitals may only see a small number of cases over long periods, and anaesthetists may not be involved in such cases for years. Therefore, a large-scale prospective cohort is needed to gain a deep understanding of events leading up to cardiac arrest, management of the arrest itself and patient outcomes. Consequently, the Royal College of Anaesthetists chose peri-operative cardiac arrest as the 7th National Audit Project topic. The study was open to all UK hospitals offering anaesthetic services and had a three-part design. First, baseline surveys of all anaesthetic departments and anaesthetists in the UK, examining respondents' prior peri-operative cardiac arrest experience, resuscitation training and local departmental preparedness. Second, an activity survey to record anonymised details of all anaesthetic activity in each site over 4 days, enabling national estimates of annual anaesthetic activity, complexity and complication rates. Third, a case registry of all instances of peri-operative cardiac arrest in the UK, reported confidentially and anonymously, over 1 year starting 16 June 2021, followed by expert review using a structured process to minimise bias. The definition of peri-operative cardiac arrest was the delivery of five or more chest compressions and/or defibrillation in a patient having a procedure under the care of an anaesthetist. The peri-operative period began with the World Health Organization `sign-in´checklist or first hands-on contact with the patient and ended either 24 h after the patient handover (e.g. to the recovery room or intensive care unit) or at discharge if this occured earlier than 24 h. These components described the epidemiology of peri-operative cardiac arrest in the UK and provide a basis for developing guidelines and interventional studies.

Patient characteristics, anaesthetic workload and techniques in the UK: an analysis from the 7th National Audit Project (NAP7) activity survey

“…D. Kane, 1,2 J. Soar, 3 R. A. Armstrong, 1,4 E. Kursumovic, 1,5 M. T. Davies, 6 F. C. Oglesby, 7 L. Cortes, 8 C. Taylor, 8 I. K. Moppett, 9,10 S. Agarwal, 11 J. Cordingley, 12 J. Dorey, 13 S. J. Finney, 12 G. Kunst, 14 D. N. Lucas, 15 G. Nickols, 16 R. Mouton, 16 J. P. Nolan, 17 B. Patel, 13 V. J. Pappachan, 18 F. Plaat, 19 B. R. Scholefield, 20 J. H. Smith, 21 L. Varney, 22 T. M. Cook 5,23 and collaborators*…”

“…Activity data enable the incidence of the complications and events relevant to the project theme (e.g. peri-operative cardiac arrest for NAP7) to be contextualised to the whole peri-operative population [4][5][6]. However, these surveys also offer an in-depth picture of the current state of the nation in terms of the number of anaesthetic procedures, the characteristics of the anaesthetic population and the anaesthetic techniques used.…”

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

“…Currently, the International Liaison Committee on Resuscitation (ILCOR) has the most comprehensive international representation of any group of resuscitation experts but has yet to review the science and publish treatment recommendations on perioperative cardiac arrest. The Advanced Life Support Task Force of ILCOR may review this topic in the future and may be informed partly by the findings of the Royal College of Anaesthetists 7th National Audit Project (NAP7) [ 5 ]. The NAP7 steering group has reviewed all perioperative cardiac arrests occurring in UK hospitals over a 1-year period and will report its findings in a series of papers in 2023.…”

In-hospital cardiac arrest

“…The relatively higher survival seen in the CCL and operating room is most likely because of arrests being witnessed and monitored, and having a treatable reversible cause. A large UK audit is studying all UK peri-operative cardiac arrests over a 1-year period (2021–2022) and will report its findings in 2023 [10].…”