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Improved Survival After Intraoperative Cardiac Arrest in Noncardiac Surgical Patients

Improved Survival After Intraoperative Cardiac Arrest in Noncardiac Surgical Patients Abstract Objective: To test the hypothesis that improvements in intraoperative and perioperative critical care are resulting in an improved outcome after intraoperative cardiac arrest. Design: A retrospective consecutive series of patients who experienced an intraoperative cardiac arrest during noncardiothoracic surgical procedures between January 1986 and June 1994. Setting: A tertiary care university-based hospital. Participants: Twenty-four consecutive patients who experienced an intraoperative arrest among 162 661 noncardiothoracic surgical procedures during the designated period. Intervention: Advanced cardiac life support and advanced trauma life support methods were used appropriately. Postarrest pharmacologic and mechanical cardiopulmonary support were used as needed in the setting of a surgical intensive care unit. Main Outcome Measures: Survival out of the operating room and survival to discharge. Results: Fifteen patients (62%) were resuscitated in the operating room and taken to the surgical intensive care unit or recovery room. Nine patients (38%) survived to discharge from the hospital. Twelve arrests (50%) were primarily cardiac in origin. Predictors of mortality included a need for pressor or inotropic support (P<.001) and duration of the arrest greater than 15 minutes (P<.001). Conclusion: Survival from an intraoperative cardiac arrest in a noncardiothoracic surgical patient is much improved over rates in historical controls who experienced in-hospital and out-of-hospital cardiac arrest. Rapid identification and aggressive correction of mechanical and metabolic derangements is warranted.(Arch Surg. 1995;130:15-18) References 1. Kouwenhoven WB, Jude JR, Knickerbocker GG. Closed-chest cardiac massage . JAMA . 1960;173:1064-1067.Crossref 2. Hinchey PR, Straehley CJ. Cardiac arrest in the operating room . N Engl J Med . 1952;247:1003-1010.Crossref 3. Turk LN, Glenn WW. Cardiac arrest . N Engl J Med . 1954;251:795-803.Crossref 4. Ament R, Papper EM, Rovenstine EA. Cardiac arrest during anesthesia . Ann Surg . 1951;134:220-227.Crossref 5. Stephenson HE, Reid L, Hinton JW. Some common denominators in 1200 cases of cardiac arrest . Ann Surg . 1953;137:731-744.Crossref 6. Briggs BD, Sheldon DB, Beecher HK. Cardiac arrest . JAMA . 1956;160:1439-1444.Crossref 7. Jordan D, Lavin T, Hamelberg W. Resuscitation experience within the hospital . JAMA . 1964;188:181-182.Crossref 8. DeBard ML. Cardiopulmonary resuscitation: analysis of six years' experience and review of the literature . Ann Emerg Med . 1981;10:408-416.Crossref 9. Bedell SE, Delbanco TL, Cook EF, Epstein FH. Survival after cardiopulmonary resuscitation in the hospital . N Engl J Med . 1983;309:569-576.Crossref 10. McGrath RB. In house cardiopulmonary resuscitation after a quarter of a century . Ann Emerg Med . 1987;16:1365-1368.Crossref 11. American Heart Association. Standards and guidelines for cardiopulmonary resuscitation (CPR) and emergency cardiac care (ECC) . JAMA . 1986:255:2905.Crossref 12. Eisenberg MS. Bergner L, Hallstrom A. Cardiac resuscitation in the community . JAMA . 1979:241:1905-1907.Crossref 13. Baum RS, Alvarez H, Cobb LA. Survival after resuscitation from out-ofhospital ventricular fibrillation . Circulation . 1974;50:1231-1235.Crossref 14. Liberthson RR, Nagel EL, Hirschman JC, Nussenfeld SR. Prehospital ventricular defibrillation . N Engl J Med . 1974;291:317-321.Crossref 15. Schaffer WA, Cobb LA. Recurrent ventricular fibrillation and modes of death in survivors of out-of-hospital ventricular fibrillation . N Engl J Med . 1975:293: 259-262.Crossref 16. Textbook of Advanced Trauma Life Support . Chicago, Ill: American College of Surgeons: 1993. 17. Miller FA, Brown EB. Buckley JJ, van Bergen FH, Varco RL. Respiratory acidosis: its relationship to cardiac function and other physiologic mechanisms . Surgery . 1952:32:171. 18. Jude JR, Kouwenhoven WB, Knickerbocker GG. Cardiac arrest . JAMA . 1961; 178:1063-1070.Crossref 19. Walker RM. DNR in the OR . JAMA . 1991;266:2407-2412.Crossref http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Archives of Surgery American Medical Association

Improved Survival After Intraoperative Cardiac Arrest in Noncardiac Surgical Patients

Archives of Surgery , Volume 130 (1) – Jan 1, 1995

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Publisher
American Medical Association
Copyright
Copyright © 1995 American Medical Association. All Rights Reserved.
ISSN
0004-0010
eISSN
1538-3644
DOI
10.1001/archsurg.1995.01430010017002
Publisher site
See Article on Publisher Site

Abstract

Abstract Objective: To test the hypothesis that improvements in intraoperative and perioperative critical care are resulting in an improved outcome after intraoperative cardiac arrest. Design: A retrospective consecutive series of patients who experienced an intraoperative cardiac arrest during noncardiothoracic surgical procedures between January 1986 and June 1994. Setting: A tertiary care university-based hospital. Participants: Twenty-four consecutive patients who experienced an intraoperative arrest among 162 661 noncardiothoracic surgical procedures during the designated period. Intervention: Advanced cardiac life support and advanced trauma life support methods were used appropriately. Postarrest pharmacologic and mechanical cardiopulmonary support were used as needed in the setting of a surgical intensive care unit. Main Outcome Measures: Survival out of the operating room and survival to discharge. Results: Fifteen patients (62%) were resuscitated in the operating room and taken to the surgical intensive care unit or recovery room. Nine patients (38%) survived to discharge from the hospital. Twelve arrests (50%) were primarily cardiac in origin. Predictors of mortality included a need for pressor or inotropic support (P<.001) and duration of the arrest greater than 15 minutes (P<.001). Conclusion: Survival from an intraoperative cardiac arrest in a noncardiothoracic surgical patient is much improved over rates in historical controls who experienced in-hospital and out-of-hospital cardiac arrest. Rapid identification and aggressive correction of mechanical and metabolic derangements is warranted.(Arch Surg. 1995;130:15-18) References 1. Kouwenhoven WB, Jude JR, Knickerbocker GG. Closed-chest cardiac massage . JAMA . 1960;173:1064-1067.Crossref 2. Hinchey PR, Straehley CJ. Cardiac arrest in the operating room . N Engl J Med . 1952;247:1003-1010.Crossref 3. Turk LN, Glenn WW. Cardiac arrest . N Engl J Med . 1954;251:795-803.Crossref 4. Ament R, Papper EM, Rovenstine EA. Cardiac arrest during anesthesia . Ann Surg . 1951;134:220-227.Crossref 5. Stephenson HE, Reid L, Hinton JW. Some common denominators in 1200 cases of cardiac arrest . Ann Surg . 1953;137:731-744.Crossref 6. Briggs BD, Sheldon DB, Beecher HK. Cardiac arrest . JAMA . 1956;160:1439-1444.Crossref 7. Jordan D, Lavin T, Hamelberg W. Resuscitation experience within the hospital . JAMA . 1964;188:181-182.Crossref 8. DeBard ML. Cardiopulmonary resuscitation: analysis of six years' experience and review of the literature . Ann Emerg Med . 1981;10:408-416.Crossref 9. Bedell SE, Delbanco TL, Cook EF, Epstein FH. Survival after cardiopulmonary resuscitation in the hospital . N Engl J Med . 1983;309:569-576.Crossref 10. McGrath RB. In house cardiopulmonary resuscitation after a quarter of a century . Ann Emerg Med . 1987;16:1365-1368.Crossref 11. American Heart Association. Standards and guidelines for cardiopulmonary resuscitation (CPR) and emergency cardiac care (ECC) . JAMA . 1986:255:2905.Crossref 12. Eisenberg MS. Bergner L, Hallstrom A. Cardiac resuscitation in the community . JAMA . 1979:241:1905-1907.Crossref 13. Baum RS, Alvarez H, Cobb LA. Survival after resuscitation from out-ofhospital ventricular fibrillation . Circulation . 1974;50:1231-1235.Crossref 14. Liberthson RR, Nagel EL, Hirschman JC, Nussenfeld SR. Prehospital ventricular defibrillation . N Engl J Med . 1974;291:317-321.Crossref 15. Schaffer WA, Cobb LA. Recurrent ventricular fibrillation and modes of death in survivors of out-of-hospital ventricular fibrillation . N Engl J Med . 1975:293: 259-262.Crossref 16. Textbook of Advanced Trauma Life Support . Chicago, Ill: American College of Surgeons: 1993. 17. Miller FA, Brown EB. Buckley JJ, van Bergen FH, Varco RL. Respiratory acidosis: its relationship to cardiac function and other physiologic mechanisms . Surgery . 1952:32:171. 18. Jude JR, Kouwenhoven WB, Knickerbocker GG. Cardiac arrest . JAMA . 1961; 178:1063-1070.Crossref 19. Walker RM. DNR in the OR . JAMA . 1991;266:2407-2412.Crossref

Journal

Archives of SurgeryAmerican Medical Association

Published: Jan 1, 1995

References