Predictors of Survival from Perioperative Cardiopulmonary Arrests

Abstract

Background Perioperative cardio-pulmonary arrests are uncommon and little is known about rates and predictors of in-hospital survival. Methods Using the Get-With-The-Guidelines – Resuscitation national cardiopulmonary resuscitation registry, we identified all patients aged 18 years or older who experienced an index, pulseless cardiac arrest in the operating room or within 24 hours postoperatively. The primary outcome was survival to hospital discharge, and the secondary outcome was neurologically intact recovery among survivors. Multivariable logistic regression models using generalized estimating equation models were used to identify independent predictors of survival and neurologically intact survival. Results There were 2,524 perioperative cardiopulmonary arrests identified from 234 hospitals. The overall rate of survival to discharge was 31.7% (799/2,524), including 41.8% (254/608) for ventricular tachycardia and ventricular fibrillation, 30.5% (296/972) for asystole, and 26.4% (249/944) for pulseless electrical activity. Ventricular fibrillation and pulseless ventricular tachycardia were independently associated with improved survival. Asystolic arrests occurring in the operating room and post-anesthesia care unit were associated with improved survival when compared to other perioperative locations. Among patients with neurological status assessment at discharge, the rate of neurologically intact survival was 64.0% (473/739). Pre-arrest neurological status at admission, patient age, inadequate natural airway, pre-arrest ventilatory support, duration of event and event location were significant predictors of neurological status at discharge. Conclusion Among patients with a perioperative cardiac arrest, 1 in 3 survived to hospital discharge, and good neurological outcome was noted in 2 out of 3 survivors.

Incidence and prediction of intraoperative and postoperative cardiac arrest requiring cardiopulmonary resuscitation and 30-day mortality in non-cardiac surgical patients

“…Finally, we demonstrated that survival after intraoperative CPR is six times higher than survival after postoperative CPR. This observation has been shown in other studies, [17] and could be related to the fact that intraoperative cardiac arrest is witnessed, with known likely culprit and availability of resources for immediate treatment.…”

Cardiac Arrest during Hospitalization for Delivery in the United States, 1998–2011

“…This rate exceeds those previously reported after in-hospital cardiac arrest in an obstetric population in Belgium (17%), 19 in-hospital cardiac arrest in a nonobstetric population in the United States (21.2%), 20 perioperative cardiac arrest for nonobstetric surgery in the United States (31.7%), 21 and in a population of pregnant arrest victims described in a systematic review of published case reports (54%). 22 This high survival rate may reflect the relative health and fitness of the childbearing population, or the inclusion of postpartum cardiac arrest events.…”

Avaliação do desfecho de pacientes que sofreram parada cardiorrespiratória durante o intraoperatório

“…Entre estes, citam-se: o maior grau de disfunção orgânica à admissão na UTI, fibrilação ventricular como o primeiro ritmo de PCR, o uso de adrenalina após a PCR, pior status neurológico pré-PCR, maior idade, maior duração da RCP e até o local do hospital onde o evento ocorreu (5,6). Entretanto, estes estudos analisam desfechos temporais distintos, sendo que alguns focam a alta hospitalar, enquanto outros focam tempos específicos, com limite superior de 90 dias (5, 6).…”

“…Além disso, a PCR intraoperatória tem sido associada a elevada letalidade, com taxas que atingem mais de 65% de óbito antes da alta hospitalar (5 Este autor dividiu os pacientes em grupos com valores de escala acima de 10 ou abaixo de cinco, permitindo, assim, uma sensibilidade de 96% e especificidade de 86%, com valores preditivos positivos e negativos de 77% e 97%, respectivamente (61).…”

“…Dos pacientes que tiveram PCR intraoperatória, 92-96% são classificados como ASA-PS III ou maior (45,70). Entretanto, há poucos estudos para poder confirmar estes achados (2,5,6).…”