Predictors of functional outcome after intraoperative cardiac arrest.

Aged; Cardiopulmonary Resuscitation; Coma/therapy; Female; Heart Arrest/therapy; Humans; Intensive Care Units; Intraoperative Complications/therapy; Length of Stay; Male; Middle Aged; Retrospective Studies

Abstract :

[en] BACKGROUND: Few outcome data are available about intraoperative cardiac arrest (IOCA). The authors studied 90-day functional outcomes and their determinants in patients admitted to the intensive care unit after IOCA. METHODS: Patients admitted to 11 intensive care units in a period of 2000-2013 were studied retrospectively. The main outcome measure was a day-90 Cerebral Performance Category score of 1 or 2. RESULTS: Of the 140 patients (61 women and 79 men; median age, 60 yr [interquartile range, 46 to 70]), 131 patients (93.6%) had general anesthesia, 80 patients (57.1%) had emergent surgery, and 73 patients (52.1%) had IOCA during surgery. First recorded rhythms were asystole in 73 patients (52.1%), pulseless electrical activity in 44 patients (31.4%), and ventricular fibrillation/ventricular tachycardia in 23 patients (16.4%). Median times from collapse to cardiopulmonary resuscitation and return of spontaneous circulation were 0 min (0 to 0) and 10 min (5 to 20), respectively. Postcardiac arrest shock was identified in 114 patients (81.4%). Main causes of IOCA were preoperative complications (n = 46, 32.9%), complications of anesthesia (n = 39, 27.9%), and complications of surgical procedures (n = 36, 25.7%). On day 90, 63 patients (45.3%) were alive with Cerebral Performance Category score 1/2. Independent predictors of day-90 Cerebral Performance Category score 1/2 were day-1 Logistic Organ Dysfunction score (odds ratio, 0.78 per point; 95% CI, 0.71 to 0.87; P = 0.0001), ventricular fibrillation/tachycardia as first recorded rhythm (odds ratio, 4.78; 95% CI, 1.38 to 16.53; P = 0.013), and no epinephrine therapy during postcardiac arrest syndrome (odds ratio, 3.14; 95% CI, 1.29 to 7.65; P = 0.012). CONCLUSIONS: By day 90, 45% of IOCA survivors had good functional outcomes. The main outcome predictors were directly related to IOCA occurrence and postcardiac arrest syndrome; they suggest that the intensive care unit management of postcardiac arrest syndrome may be amenable to improvement.

Disciplines :

Anesthesia & intensive care

Author, co-author :

Constant, Anne-Laure

Montlahuc, Claire

Grimaldi, David

Pichon, Nicolas

Mongardon, Nicolas

Bordenave, Lauriane

Soummer, Alexis

Sauneuf, Bertrand

Ricome, Sylvie

Misset, Benoît ; Centre Hospitalier Universitaire de Liège - CHU > Service de Soins Intensifs

More authors (14 more)

Language :

English

Title :

Predictors of functional outcome after intraoperative cardiac arrest.

Publication date :

2014

Journal title :

Anesthesiology

ISSN :

0003-3022

eISSN :

1528-1175

Publisher :

Lippincott Williams & Wilkins, Philadelphia, United States - Pennsylvania

Volume :

121

Issue :

Pages :

482-91

Peer reviewed :

Peer Reviewed verified by ORBi

Available on ORBi :

since 21 February 2020

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