Perioperative cardiac arrests – A subanalysis of the anesthesia -related cardiac arrests and associated mortality

Sobreira-Fernandes, Diogo; Teixeira, Laetitia; Lemos, Tiago; Costa, Liliana; Pereira, Manuela; Costa, Antônio Célio Martins Timbó; Couto, Paula

doi:10.1016/j.jclinane.2018.06.005

Cited by 26 publications

(25 citation statements)

References 24 publications

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“…Comorbid conditions are potentially major contributors to the ongoing high rates of intra‐operative cardiac arrest in low‐HDI countries over time. As described in our review and in other studies, a poor ASA physical status (3–5) is an important predictor of intra‐operative and anaesthesia‐related cardiac arrest events [3, 27–30]. Thus, the pre‐anaesthetic management of comorbidities plays a major role in minimising intra‐operative complications and adverse effects [26, 31–34].…”

Section: Discussionmentioning

confidence: 55%

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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Section: Discussionmentioning

confidence: 55%

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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“…Higher CA incidence was found among patients with ASA physical status classifications III-V (18 of 27, 66.7% of all CA cases), in agreement with other studies. 10,16,21 Nunes et al found in their study that investigated ASA scores in an elderly population that patients with ASA physical status scores of III-V were more likely (14fold) to suffer intraoperative CA than those with ASA physical status classifications I-II. 19 Ahmed et al 5 found no survival to discharge in patients with ASA scores of IV and V, and most studies in this regard have found increased risk of perioperative CA with increasing ASA grade.…”

Section: Discussionmentioning

confidence: 99%

Perioperative Cardiac Arrest: A 3-Year Prospective Study from a Tertiary Care University Hospital

Aloweidi¹,

Alghanem²,

Bsisu³

et al. 2022

DHPS

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Purpose: Perioperative cardiac arrests (CAs) are a rare but catastrophic perioperative complication. Much about incidence, risk factors, and outcomes of such events are still unknown. This study investigated anesthesia-related CAs at a tertiary teaching hospital. Methods: CA incidence within 24 hours of anesthesia administration was prospectively identified from May 1, 2016 to April 31, 2019. Each CA was matched by four other cases without CA receiving anesthesia on the same date and under similar operating conditions. The CA cases were reviewed and assigned to one of three groups: anesthesia-related, anesthesia-contributing, and anesthesia not related. Results: A total of 58,303 patients underwent 73,557 procedures under anesthesia during the study period. In sum, 27 CAs were reported for incidence of 3.7 per 10,000 anesthesia administrations (95% CI 2.3-5.1). Eleven CA were anesthesia-related for incidence of 1.5 per 10,000 anesthesia administrations. Four CA cases were anesthesia-contributing for incidence of 0.5 per 10,000 anesthesia administrations, while 53% of the anesthesia-related and -contributing CAs were due to respiratory problems. American Society of Anesthesiologists (ASA) physical status score, cardiovascular surgery, emergency surgery, and increased duration of surgery were significantly correlated with CA incidents when compared to the control group. ASA physical status score is an independent risk factor of the occurrence of perioperative CA (OR 7.6, 95% CI 2.6-22.4; P<0.001). Conclusion: Identifying factors associated with increased risk for anesthesia-related CA is of great importance in risk stratification for surgical patients. ASA physical status score was found to be a major factor in predicting perioperative CA, since patients with higher ASA scores had a statistically significant increased risk of CA. Therefore, extra precautions must be taken when dealing with unprepared patients who have uncontrolled medical illnesses, especially those who will be undergoing emergency surgery.

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“…Fortunately, there was no anesthesia-related death during the 10-year study period. This might be because our sample size was limited and there were no perianesthetic deaths associated with failed ventilation, aspiration of gastric contents, and accidental bolus of narcotics, which can lead to anesthesia-related death and anesthesiarelated cardiac arrest [3][4][5][6].…”

Section: Discussionmentioning

confidence: 99%

“…Studies focusing on perioperative cardiac arrest have been published; however, studies focusing on perianesthetic death and anesthesia-related death are limited [3][4][5][6][7][8][9]. Two analyses of anesthesia-related death based on closed claims analysis and death certificates have been reported, but both analyses failed to provide denominators, making interpretation of the percentage of perianesthetic death difficult [8,9].…”

Section: Introductionmentioning

confidence: 99%

Perianesthetic death: a 10-year retrospective observational study in a Japanese university hospital

et al. 2020

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Background: Studies reporting on perianesthetic death and anesthesia-related death are limited. The present study aimed to assess the incidence of perianesthetic death and its relation to anesthesia and to describe the patient characteristics and main events leading to death in cases of anesthesia-related death and anesthesia-contributory death. Methods: We conducted a retrospective chart review of patients in whom anesthesia procedures were performed by anesthesiologists at a Japanese tertiary hospital between January 2008 and December 2017. Perianesthetic death was defined as death occurring within 48 h of an anesthetic, and it was divided into the following three categories: anesthesia-related death, anesthesia-contributory death, and nonanesthesia-related death. Patient demographics and perioperative factors were analyzed in cases of anesthesia-related death and anesthesia-contributory death. Results: Among 46,378 patients who underwent anesthetics, 41 experienced perianesthetic death, with an incidence of 8.8/10,000 anesthetics (95% confidence interval [CI], 6.1-11.6). No patient experienced anesthesiarelated death, whereas 10 experienced anesthesia-contributory death, with an incidence of 2.1/10,000 (95% CI, 0.69-3.6), and 31 experienced nonanesthesia-related death, with an incidence of 6.8/10,000 (95% CI, 4.2-9.1). The events leading to anesthesia-contributory death were hypovolemia, myocardial infarction, arrhythmia, and respiratory failure, and they occurred during anesthesia maintenance in 5 patients and after surgery in 5 patients. Conclusions: The incidence of perianesthetic death was 8.8/10,000 anesthetics; however, anesthesia-related death was not detected. Ten patients experienced anesthesia-contributory death, and hypovolemia during or after surgery was most frequently associated with anesthesia-contributory death.

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Perioperative cardiac arrests – A subanalysis of the anesthesia -related cardiac arrests and associated mortality

Cited by 26 publications

References 24 publications

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^*

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^*

Perioperative Cardiac Arrest: A 3-Year Prospective Study from a Tertiary Care University Hospital

Perianesthetic death: a 10-year retrospective observational study in a Japanese university hospital

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Perioperative cardiac arrests – A subanalysis of the anesthesia -related cardiac arrests and associated mortality

Cited by 26 publications

References 24 publications

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*

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*

Perioperative Cardiac Arrest: A 3-Year Prospective Study from a Tertiary Care University Hospital

Perianesthetic death: a 10-year retrospective observational study in a Japanese university hospital

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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^*

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^*