Incidence and characteristics of intra-operative cardiac arrest in a Swiss university hospital: a retrospective observational single-centre study

Fuchs, A.; Franzmeier, L.; Huber, M.; Riva, T.; Greif, R. (June 2023). Incidence and characteristics of intra-operative cardiac arrest in a Swiss university hospital: a retrospective observational single-centre study. European journal of anaesthesiology, 40, pp. 18-19. Lippincott Williams & Wilkins

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Background and Goal of Study: Intraoperative cardiac arrest is a special form of in-hospital cardiac [1]. Scare evidence on the incidence of intraoperative cardiac arrests is reported to be between 2-10 per 10,000 procedures for paediatric patients and 0.5-3 per 10,000 for adult patients. Unfortunately, there is no Swiss data published. Thus, we aimed to investigate the age-adjusted incidence of cardiac arrest patients in the operating room. Furthermore, the cardiac arrests’ association with patients’ characteristics (sex, age, ASA physical status), the urgency of the procedure, and the type of surgery are reported.
Materials and Methods: After ethics committee approval (BASEC 2021-02330) and trial registration (NCT05316779), this retrospective observational single-centre study screened all patients with cardiac arrest during anaesthesia care from 1 January 2014 to 31 December 2021. Cardiac arrest was defined as the delivery of at least five chest compressions and/or defibrillation. We included all reported cardiac arrests in the operating room. We excluded all patients with a cardiac arrest outside the operating room and procedure-related
cardiac arrest (e.g., extracorporeal circulation).
Results and Discussion: We screened 243,982 anaesthesia procedures, and 209 met the inclusion criteria. Most patients (n=144, 68.9%) were male. Median [Q1; Q3] patients’ age was 68.9 [57.8;79.5] years, including six (2,9%) patients <1 y, seven (3,3%) patients between 1-15 y, and 196 (93,8%) ≥16y of age. Nearly two-thirds of patients with cardiac arrest had an ASA physical status ≥4 (n=139, 66.5%), compared to ASA <4 patients (n=70, 33.5%). More than half of the cardiac arrests occurred during emergency procedures (n=108, 51.7%), compared to elective (n=93, 48.3%). Over two-thirds of the cardiac arrests (n=145, 69.4%) happened during non-cardiac surgery.
Conclusion(s): The overall incidence of intraoperative cardiac arrest was 8.6 (95%-CI: 7.4–9.8) per 10,000 procedures. Incidence for patients <1y of age was 12.5 (95%-CI: 4.6–27.1), for children between 1-16y of age 2.2 (95%-CI: 0.8–4.8), and patients >16y of age 9.3 (95%-CI: 8.0–10.7) per 10,000 procedures, respectively, which is a comparable incidence to published data. Risk factors for a cardiac arrest were identified as: male, cardiac surgery, ASA physical status ≥4, and emergency procedures (the higher the urgency, the
higher the risk). Our findings justify regular training for anaesthesia personnel in advanced life support in adults and children to keep up guideline-conform resuscitation competencies, which have been shown to increase patient survival. Out of this data, we aim to investigate the aetiology and the circumstances of the patient’s cardiac arrest and their long-term neurological favour survival.
Reference:
1. Fuchs, A., Käser, D., Theiler, L. et al. Survival and long-term outcomes following in-hospital cardiac arrest in a Swiss university hospital: a prospective observational study. Scand J Trauma Resusc Emerg Med 29, 115 (2021). https://doi.org/10.1186/s13049-021-00931-0
Acknowledgements: We thank the Burgergemeinde Bern for their financial support.

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