Perioperative cardiac arrest and mortality in trauma patients: A systematic review of observational studies

Braz, Leandro Gobbo; Carlucci, Marcelo T. O.; Bráz, José Reinaldo Cerqueira; Módolo, Norma Sueli Pinheiro; Nascimento, Paulo do; Braz, Mariana Gobbo

doi:10.1016/j.jclinane.2020.109813

Cited by 9 publications

(12 citation statements)

References 41 publications

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“…We conducted a factor analysis to identify the independent predictors of perioperative cardiac arrest. The meta-analysis showed that children who are younger than 1 year old, ASA physical status >3, and general anesthesia were the independent predictors of perioperative cardiac arrest which is comparable to a meta-analysis by Braz et al among trauma patients [ 73 ].…”

Section: Discussionsupporting

confidence: 72%

Global mortality of children after perioperative cardiac arrest: A systematic review, meta-analysis, and meta-regression

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Nega

Basu

et al. 2022

Annals of Medicine &Amp; Surgery

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Section: Discussionsupporting

confidence: 72%

Global mortality of children after perioperative cardiac arrest: A systematic review, meta-analysis, and meta-regression

Abate

Nega

Basu

et al. 2022

Annals of Medicine &Amp; Surgery

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“…The most influential cause of perioperative CA and mortality events in Brazilian studies was sepsis, followed by trauma [ 23 , 29 , 30 , 37 ]. Therefore, comorbid conditions seem to be major contributors to the high perioperative CA and mortality rates in Brazil [ 5 ].…”

Section: Discussionmentioning

confidence: 99%

Perioperative and anesthesia-related cardiac arrest and mortality rates in Brazil: A systematic review and proportion meta-analysis

et al. 2020

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Introduction Studies have shown that both perioperative and anesthesia-related cardiac arrest (CA) and mortality rates are much higher in developing countries than in developed countries. This review aimed to compare the rates of perioperative and anesthesia-related CA and mortality during 2 time periods in Brazil. Methods A systematic review with meta-analysis of full-text Brazilian observational studies was conducted by searching the Medline, EMBASE, LILACS and SciELO databases up to January 29, 2020. The primary outcomes were perioperative CA and mortality rates and the secondary outcomes included anesthesia-related CA and mortality events rates up to 48 postoperative hours. Results Eleven studies including 719,273 anesthetic procedures, 962 perioperative CAs, 134 anesthesia-related CAs, 1,239 perioperative deaths and 29 anesthesia-related deaths were included. The event rates were evaluated in 2 time periods: pre-1990 and 1990–2020. Perioperative CA rates (per 10,000 anesthetics) decreased from 39.87 (95% confidence interval [CI]: 34.60–45.50) before 1990 to 17.61 (95% CI: 9.21–28.68) in 1990–2020 (P < 0.0001), while the perioperative mortality rate did not alter (from 19.25 [95% CI: 15.64–23.24] pre-1990 to 25.40 [95% CI: 13.01–41.86] in 1990–2020; P = 0.1984). Simultaneously, the anesthesia-related CA rate decreased from 14.39 (95% CI: 11.29–17.86) to 3.90 (95% CI: 2.93–5.01; P < 0.0001), while there was no significant difference in the anesthesia-related mortality rate (from 1.75 [95% CI: 0.76–3.11] to 0.67 [95% CI: 0.09–1.66; P = 0.5404). Conclusions This review demonstrates an important reduction in the perioperative CA rate over time in Brazil, with a large and consistent decrease in the anesthesia-related CA rate; however, there were no significant differences in perioperative and anesthesia-related mortality rates between the assessed time periods.

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“…Poor physical status of trauma patients poses a challenge to modern anaesthesia and surgery [32]. Uncontrolled haemorrhage remains the greatest threat, occurring in approximately 40–60% of patients with intra‐operative cardiac arrests and deaths related to trauma [40, 41].…”

Section: Discussionmentioning

confidence: 99%

Association between intra‐operative cardiac arrest and country Human Development Index status: a systematic review with meta‐regression analysis and meta‐analysis of observational studies^*

et al. 2021

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Summary Intra‐operative cardiac arrests differ from most in‐hospital cardiac arrests because they reflect not only the patient's condition but also the quality of surgery and anaesthesia care provided. We assessed the relationship between intra‐operative cardiac arrest rates and country Human Development Index (HDI), and the changes occurring in these rates over time. We searched PubMed, EMBASE, Scopus, LILACS, Web of Science, CINAHL and SciELO from inception to 29 January 2020. For the global population, rates of intra‐operative cardiac arrest and baseline ASA physical status were extracted. Intra‐operative cardiac arrest rates were analysed by time, country HDI status and ASA physical status using meta‐regression analysis. Proportional meta‐analysis was performed to compare intra‐operative cardiac arrest rates and ASA physical status in low‐ vs. high‐HDI countries and in two time periods. Eighty‐two studies from 25 countries with more than 29 million anaesthetic procedures were included. Intra‐operative cardiac arrest rates were inversely correlated with country HDI (p = 0.0001); they decreased over time only in high‐HDI countries (p = 0.040) and increased with increasing ASA physical status (p < 0.0001). Baseline ASA physical status did not change in high‐HDI countries (p = 0.106), while it decreased over time in low‐HDI countries (p = 0.040). In high‐HDI countries, intra‐operative cardiac arrest rates (per 10,000 anaesthetic procedures) decreased from 9.59 (95%CI 6.59–13.16) pre‐1990 to 5.17 (95%CI 4.42–5.97) in 1990–2020 (p = 0.013). During the same time periods, no improvement was observed in the intra‐operative cardiac arrest rates in low‐HDI countries (p = 0.498). Odds ratios of intra‐operative cardiac arrest rates in ASA 3–5 patients were 8.48 (95%CI 1.67–42.99) times higher in low‐HDI countries than in high‐HDI countries (p = 0.0098). Intra‐operative cardiac arrest rates are related to country‐HDI and decreased over time only in high‐HDI countries. The widening gap in these rates between low‐ and high‐HDI countries needs to be addressed globally.

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Perioperative cardiac arrest and mortality in trauma patients: A systematic review of observational studies

Cited by 9 publications

References 41 publications

Global mortality of children after perioperative cardiac arrest: A systematic review, meta-analysis, and meta-regression

Global mortality of children after perioperative cardiac arrest: A systematic review, meta-analysis, and meta-regression

Perioperative and anesthesia-related cardiac arrest and mortality rates in Brazil: A systematic review and proportion meta-analysis

Association between intra‐operative cardiac arrest and country Human Development Index status: a systematic review with meta‐regression analysis and meta‐analysis of observational studies^*

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Perioperative cardiac arrest and mortality in trauma patients: A systematic review of observational studies

Cited by 9 publications

References 41 publications

Global mortality of children after perioperative cardiac arrest: A systematic review, meta-analysis, and meta-regression

Global mortality of children after perioperative cardiac arrest: A systematic review, meta-analysis, and meta-regression

Perioperative and anesthesia-related cardiac arrest and mortality rates in Brazil: A systematic review and proportion meta-analysis

Association between intra‐operative cardiac arrest and country Human Development Index status: a systematic review with meta‐regression analysis and meta‐analysis of observational studies*

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Association between intra‐operative cardiac arrest and country Human Development Index status: a systematic review with meta‐regression analysis and meta‐analysis of observational studies^*