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Chalkias A, Mentzelopoulos SD, Tissier R, Mongardon N. Peri-operative cardiac arrest and resuscitation: Towards an innovative, physiologically based road map. Eur J Anaesthesiol 2024; 41:393-396. [PMID: 38567683 DOI: 10.1097/eja.0000000000001944] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/04/2024]
Affiliation(s)
- Athanasios Chalkias
- From the Institute for Translational Medicine and Therapeutics, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania (AC), Outcomes Research Consortium, Cleveland, Ohio, USA (AC), First Department of Intensive Care Medicine, National and Kapodistrian University of Athens Medical School, Athens, Greece (SDM), Ecole Nationale Vétérinaire d'Alfort, Univ Paris Est Créteil, INSERM, IMRB (RT, NM), Service d'Anesthésie-Réanimation Chirurgicale, DMU CARE, DHU A-TVB, Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpitaux Universitaires Henri Mondor (NM), Faculté de Santé, Univ Paris Est Créteil, Créteil, France (NM)
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Ben-Jacob TK, Pasch S, Patel AD, Mueller D. Intraoperative cardiac arrest management. Int Anesthesiol Clin 2023; 61:1-8. [PMID: 37589144 DOI: 10.1097/aia.0000000000000412] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/18/2023]
Affiliation(s)
- Talia K Ben-Jacob
- Department of Anesthesiology, Division of Critical Care Cooper University Hospital, Camden, NJ
| | - Stuart Pasch
- Department of Anesthesiology Cooper University Hospital, Camden, NJ
| | - Akhil D Patel
- Department of Anesthesiology, Division of Critical Care, The George Washington University Hospital, Washington, DC
| | - Dorothee Mueller
- Department of Anesthesiology, Division of Critical Care Vanderbilt University Medical Center Nashville, TN
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de Roux Q, Chalkias A, Xanthos T, Mongardon N. In-hospital cardiac arrest: evidence and specificities of perioperative cardiac arrest. Crit Care 2023; 27:17. [PMID: 36639660 PMCID: PMC9840306 DOI: 10.1186/s13054-022-04300-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2022] [Accepted: 12/29/2022] [Indexed: 01/15/2023] Open
Affiliation(s)
- Quentin de Roux
- grid.412116.10000 0004 1799 3934Service d’Anesthésie-Réanimation Chirurgicale, DMU CARE, DHU A-TVB, Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpitaux Universitaires Henri Mondor, 1 rue Gustave Eiffel, 94000 Créteil, France ,grid.428547.80000 0001 2169 3027U955-IMRB, Equipe 03 “Pharmacologie et Technologies pour les Maladies Cardiovasculaires (PROTECT)”, Inserm Univ Paris Est Créteil (UPEC), Ecole Nationale Vétérinaire d’Alfort (EnVA), 94700 Maisons-Alfort, France ,grid.410511.00000 0001 2149 7878Faculté de Santé, Univ Paris Est Créteil, 94010 Créteil, France
| | - Athanasios Chalkias
- grid.410558.d0000 0001 0035 6670Department of Anesthesiology, Faculty of Medicine, University of Thessaly, 41100 Larissa, Greece ,grid.512286.aOutcomes Research Consortium, 9500 Euclid Avenue, Cleveland, OH 44195 USA
| | - Theodoros Xanthos
- grid.499377.70000 0004 7222 9074School of Health Sciences, University of West Attica, 12243 Athens, Greece
| | - Nicolas Mongardon
- grid.412116.10000 0004 1799 3934Service d’Anesthésie-Réanimation Chirurgicale, DMU CARE, DHU A-TVB, Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpitaux Universitaires Henri Mondor, 1 rue Gustave Eiffel, 94000 Créteil, France ,grid.428547.80000 0001 2169 3027U955-IMRB, Equipe 03 “Pharmacologie et Technologies pour les Maladies Cardiovasculaires (PROTECT)”, Inserm Univ Paris Est Créteil (UPEC), Ecole Nationale Vétérinaire d’Alfort (EnVA), 94700 Maisons-Alfort, France ,grid.410511.00000 0001 2149 7878Faculté de Santé, Univ Paris Est Créteil, 94010 Créteil, France
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Geube MA, Hsu A, Skubas NJ, Liang C, Mi J, Knuf KM, Marciniak D, Tong MZY, Duncan AE. Incidence, Outcomes, and Risk Factors for Preincision Cardiac Arrest in Cardiac Surgery Patients. Anesth Analg 2022; 135:1189-1197. [PMID: 36155546 DOI: 10.1213/ane.0000000000006081] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
BACKGROUND We examined the incidence, postoperative outcomes, and patient-related factors associated with preincision cardiac arrest in patients undergoing cardiac surgery. METHODS We retrospectively examined adult patients undergoing elective or urgent cardiac surgery at the Cleveland Clinic between 2008 and 2019. The incidence of preincision cardiac arrest, defined as arrest between induction of general anesthesia and surgical incision, was reported. In a secondary analysis, we assessed the association between preincision cardiac arrest and major postoperative outcomes. In a tertiary analysis, we used adjusted linear regression models to explore the association between preincision cardiac arrest and prespecified patient risk factors, including severe left main coronary artery stenosis, left ventricular ejection fraction, moderate/severe right ventricular dysfunction, low-flow low-gradient aortic stenosis, and moderate/severe pulmonary hypertension. RESULTS Preincision cardiac arrests occurred in 75 of 41,238 (incidence of 0.18%; 95% CI, 0.17-0.26) patients who had elective or urgent cardiac surgery. Successful cardiopulmonary resuscitation with return of spontaneous circulation or bridge to cardiopulmonary bypass occurred in 74 of 75 (98.6%) patients. Patients who experienced preincision cardiac arrest had significantly higher in-hospital mortality than those who did not (11% vs 2%; odds ratio [OR] (95% CI), 4.14 (1.94-8.84); P < .001). They were also more likely to suffer postoperative respiratory failure (46% vs 13%; OR [95% CI], 3.94 [2.40-6.47]; P < .001), requirement for renal replacement therapy (11% vs 2%; OR [95% CI], 3.90 [1.82-8.35]; P < .001), neurologic deficit (7% vs 2%; OR [95% CI], 2.49 (1.00-6.21); P = .05), and longer median hospital stay (15 vs 8 days; hazard ratio (HR) [95% CI], 0.68 [0.55-0.85]; P < .001). Reduced left ventricular ejection fraction (per 5% decrease) (OR [95% CI], 1.13 [1.03-1.22]; P = .006) and moderate/severe pulmonary hypertension (OR [95% CI], 3.40 [1.95-5.90]; P < .001) were identified as independent risk factors for cardiac arrest. CONCLUSIONS Cardiac arrest after anesthetic induction is rare in cardiac surgical patients in our investigation. Though most patients are rescued, morbidity and mortality remain higher. Reduced left ventricular ejection fraction and moderate/severe pulmonary hypertension are associated with greater risk for preincision cardiac arrest.
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Affiliation(s)
| | - Albert Hsu
- From the Departments of Cardiothoracic Anesthesiology
| | | | | | | | - Kayla M Knuf
- From the Departments of Cardiothoracic Anesthesiology
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A retrospective study of mortality for perioperative cardiac arrests toward a personalized treatment. Sci Rep 2022; 12:13709. [PMID: 35961996 PMCID: PMC9374678 DOI: 10.1038/s41598-022-17916-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2022] [Accepted: 08/02/2022] [Indexed: 11/10/2022] Open
Abstract
Perioperative cardiac arrest (POCA) is associated with a high mortality rate. This work aimed to study its prognostic factors for risk mitigation by means of care management and planning. A database of 380,919 surgeries was reviewed, and 150 POCAs were curated. The main outcome was mortality prior to hospital discharge. Patient demographic, medical history, and clinical characteristics (anesthesia and surgery) were the main features. Six machine learning (ML) algorithms, including LR, SVC, RF, GBM, AdaBoost, and VotingClassifier, were explored. The last algorithm was an ensemble of the first five algorithms. k-fold cross-validation and bootstrapping minimized the prediction bias and variance, respectively. Explainers (SHAP and LIME) were used to interpret the predictions. The ensemble provided the most accurate and robust predictions (AUC = 0.90 [95% CI, 0.78–0.98]) across various age groups. The risk factors were identified by order of importance. Surprisingly, the comorbidity of hypertension was found to have a protective effect on survival, which was reported by a recent study for the first time to our knowledge. The validated ensemble classifier in aid of the explainers improved the predictive differentiation, thereby deepening our understanding of POCA prognostication. It offers a holistic model-based approach for personalized anesthesia and surgical treatment.
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Lee JH, Han WH, Kim JH. Clinical Characteristics of Intraoperative Cardiac Arrest During Cancer Surgery. JOURNAL OF ACUTE CARE SURGERY 2021. [DOI: 10.17479/jacs.2021.11.3.114] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
Purpose: Intraoperative cardiac arrest (IOCA) is rare, unpredictable, and may result in a poor outcome. The features of IOCA during cancer surgery and factors related to survival following an IOCA were examined.Methods: This was a retrospective study of patients who had cancer surgery under general anesthesia between March 2009 and March 2021 (<i>n</i> = 84,615) to determine the number of patients who had an IOCA. Patients’ clinical information, cause of IOCA, hypoxemia during anesthesia, and the duration of hypotension and CPR were analyzed.Results: A total of 22 cases of IOCA occurred during cancer surgery (overall incidence: 2.6 per 10,000 surgeries). Return of spontaneous circulation was achieved in 17 patients, but only 13 survived until discharge. There were statistically significant differences between the deceased and the survival cancer patient groups in; (1) duration of hypoxemia (survival group: 5 minutes, range: 2-18 minutes; deceased group: 60 minutes, range, 22.5-120 minutes; <i>p</i> = 0.019); (2) duration of hypotension (survival group: 35 minutes, range, 15-55 minutes; deceased group 160 minutes, range, 140-185 minutes; <i>p</i> = 0.007); and (3) total duration of CPR (survival group: 3 minutes, range: 1-15 minutes; deceased group: 40 minutes, range: 19-149 minutes; <i>p</i> = 0.005).Conclusion: The duration of hypoxemia and hypotension prior to the onset of IOCA, as well as the duration of CPR were associated with the prognosis of IOCA, highlighting the need to reduce multiorgan damage caused by hypoxemia and hypotension during surgery in high-risk patients.
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Chalkias A, Mongardon N, Boboshko V, Cerny V, Constant AL, De Roux Q, Finco G, Fumagalli F, Gkamprela E, Legriel S, Lomivorotov V, Magliocca A, Makaronis P, Mamais I, Mani I, Mavridis T, Mura P, Ristagno G, Sardo S, Papagiannakis N, Xanthos T. Clinical practice recommendations on the management of perioperative cardiac arrest: A report from the PERIOPCA Consortium. CRITICAL CARE : THE OFFICIAL JOURNAL OF THE CRITICAL CARE FORUM 2021; 25:265. [PMID: 34325723 PMCID: PMC8323279 DOI: 10.1186/s13054-021-03695-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/24/2021] [Accepted: 07/19/2021] [Indexed: 12/02/2022]
Abstract
Background Perioperative cardiac arrest is a rare complication with an incidence of around 1 in 1400 cases, but it carries a high burden of mortality reaching up to 70% at 30 days. Despite its specificities, guidelines for treatment of perioperative cardiac arrest are lacking. Gathering the available literature may improve quality of care and outcome of patients. Methods The PERIOPCA Task Force identified major clinical questions about the management of perioperative cardiac arrest and framed them into the therapy population [P], intervention [I], comparator [C], and outcome [O] (PICO) format. Systematic searches of PubMed, Embase, and the Cochrane Library for articles published until September 2020 were performed. Consensus-based treatment recommendations were created using the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) system. The strength of consensus among the Task Force members about the recommendations was assessed through a modified Delphi consensus process. Results Twenty-two PICO questions were addressed, and the recommendations were validated in two Delphi rounds. A summary of evidence for each outcome is reported and accompanied by an overall assessment of the evidence to guide healthcare providers. Conclusions The main limitations of our work lie in the scarcity of good quality evidence on this topic. Still, these recommendations provide a basis for decision making, as well as a guide for future research on perioperative cardiac arrest. Supplementary Information The online version contains supplementary material available at 10.1186/s13054-021-03695-2.
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Affiliation(s)
- Athanasios Chalkias
- Department of Anesthesiology, Faculty of Medicine, University of Thessaly, Larisa, Greece. .,Outcomes Research Consortium, Cleveland, OH, 44195, USA. .,Hellenic Society of Cardiopulmonary Resuscitation, Athens, Greece. .,Department of Anesthesiology, University Hospital of Larisa, Biopolis, Mezourlo, 41110, Larisa, Greece.
| | - Nicolas Mongardon
- Service D'anesthésie-Réanimation Chirurgicale, DMU CARE, DHU A-TVB, Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpitaux Universitaires Henri Mondor, Univ Paris Est Créteil, Faculté de Santé, 94010, Créteil, France.,U955-IMRB, Equipe 03 "Pharmacologie Et Technologies Pour Les Maladies Cardiovasculaires (PROTECT)", Inserm, Univ Paris Est Créteil (UPEC), Ecole Nationale Vétérinaire d'Alfort (EnVA), 94700, Maisons-Alfort, France
| | - Vladimir Boboshko
- Department of Anesthesiology and Intensive Care, E. Meshalkin National Medical Research Center, Novosibirsk, Russian Federation
| | - Vladimir Cerny
- Department of Anesthesiology, Perioperative Medicine and Intensive Care, Masaryk Hospital, J.E. Purkinje University, Usti Nad Labem, Czech Republic.,Center for Research and Development, University Hospital, Hradec Kralove, Czech Republic
| | - Anne-Laure Constant
- Service D'Anesthésie Et Réanimation, Hôpital Européen Georges Pompidou, Assistance Publique-Hôpitaux de Paris, 75015, Paris, France
| | - Quentin De Roux
- Service D'anesthésie-Réanimation Chirurgicale, DMU CARE, DHU A-TVB, Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpitaux Universitaires Henri Mondor, Univ Paris Est Créteil, Faculté de Santé, 94010, Créteil, France.,U955-IMRB, Equipe 03 "Pharmacologie Et Technologies Pour Les Maladies Cardiovasculaires (PROTECT)", Inserm, Univ Paris Est Créteil (UPEC), Ecole Nationale Vétérinaire d'Alfort (EnVA), 94700, Maisons-Alfort, France
| | - Gabriele Finco
- Department of Medical Sciences and Public Health, University of Cagliari, Cagliari, Italy
| | - Francesca Fumagalli
- Laboratory of Cardiopulmonary Pathophysiology, Department of Cardiovascular Medicine, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Milan, Italy
| | - Eleana Gkamprela
- National and Kapodistrian University of Athens, Medical School, Postgraduate Study Course (MSc) "Resuscitation", Athens, Greece
| | - Stéphane Legriel
- Medical-Surgical Intensive Care Unit, Centre Hospitalier de Versailles - Site André Mignot, 177 Rue de Versailles, Le Chesnay, France.,University Paris-Saclay, UVSQ, INSERM, CESP, Team «PsyDev», Villejuif, France.,AfterROSC, Paris, France
| | - Vladimir Lomivorotov
- Department of Anesthesiology and Intensive Care, E. Meshalkin National Medical Research Center, Novosibirsk, Russian Federation.,Novosibirsk State University, Novosibirsk, Russian Federation
| | - Aurora Magliocca
- Laboratory of Cardiopulmonary Pathophysiology, Department of Cardiovascular Medicine, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Milan, Italy
| | - Panagiotis Makaronis
- National and Kapodistrian University of Athens, Medical School, Postgraduate Study Course (MSc) "Resuscitation", Athens, Greece
| | - Ioannis Mamais
- Department of Health Sciences, European University Cyprus, Nicosia, Cyprus
| | - Iliana Mani
- National and Kapodistrian University of Athens, Medical School, Postgraduate Study Course (MSc) "Resuscitation", Athens, Greece
| | - Theodoros Mavridis
- 1st Department of Neurology, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Paolo Mura
- Department of Medical Sciences and Public Health, University of Cagliari, Cagliari, Italy
| | - Giuseppe Ristagno
- Department of Anesthesiology, Intensive Care and Emergency, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy.,Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy
| | - Salvatore Sardo
- Department of Medical Sciences and Public Health, University of Cagliari, Cagliari, Italy
| | - Nikolaos Papagiannakis
- 1st Department of Neurology, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Theodoros Xanthos
- Hellenic Society of Cardiopulmonary Resuscitation, Athens, Greece.,School of Medicine, European University Cyprus, Nicosia, Cyprus
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Braz LG, Braz MG, Tiradentes TAA, Braz JRC. A correlation between anaesthesia-related cardiac arrest outcomes and country human development index: A narrative review. J Clin Anesth 2021; 72:110273. [PMID: 33957413 DOI: 10.1016/j.jclinane.2021.110273] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2021] [Revised: 03/16/2021] [Accepted: 03/24/2021] [Indexed: 10/21/2022]
Abstract
Studies have demonstrated gaps between developed and developing countries in the quality of surgical and anaesthesia care. The aim of this review was to provide a critical overview of documented outcomes from the 2010s of anaesthesia-related cardiac arrest events in countries with largely differing Human Development Indexes (HDIs). The HDI ranges from 0 to 1, representing the lowest and highest levels of development, respectively. Most related studies conducted between 2011 and 2020 showed low rates (from 0 to 215 per million anaesthetics) of anaesthesia-related mortality up to the 30th postoperative day in very high-HDI countries (HDI ≥ 0.800) and higher rates (from 0 to 915.4 per million anaesthetics) in high-HDI countries (HDI: 0.700-0.799). Low-HDI countries (HDI < 0.550) showed higher anaesthesia-related mortality rates, which were greater than 1500 per million anaesthetics. The anaesthesia-related mortality rates per quartile demonstrated a gap in the anaesthesia-related safety between very high- and high-HDI countries, and especially between very high- and low-HDI countries. Anaesthesia-related cardiac arrest showed similarly high survival proportions in very high-HDI countries (45.9% to 100%) and high-HDI countries (62.9% to 100%), while in a low-HDI country, the anaesthesia-related cardiac arrest survival was lower (22.2%). Our review demonstrates large gaps among countries with largely differing HDIs regarding anaesthesia-related cardiac arrest outcomes in the last decade. This finding highlights the need to improve patient safety care in low-HDI countries. Anaesthesia patient safety has improved in high-HDI countries, but there is still a persistent gap in the health care systems of these countries and those of very high-HDI countries. Our review also found a consistent improvement in anaesthesia patient safety in very high-HDI countries.
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Affiliation(s)
- Leandro G Braz
- Anaesthesia Cardiac Arrest and Mortality Study Commission, Department of Surgical Specialties and Anaesthesiology, Botucatu Medical School, Sao Paulo State University - UNESP, Botucatu, SP, Brazil.
| | - Mariana G Braz
- Anaesthesia Cardiac Arrest and Mortality Study Commission, Department of Surgical Specialties and Anaesthesiology, Botucatu Medical School, Sao Paulo State University - UNESP, Botucatu, SP, Brazil
| | - Teófilo Augusto A Tiradentes
- Anaesthesia Cardiac Arrest and Mortality Study Commission, Department of Surgical Specialties and Anaesthesiology, Botucatu Medical School, Sao Paulo State University - UNESP, Botucatu, SP, Brazil
| | - José Reinaldo C Braz
- Anaesthesia Cardiac Arrest and Mortality Study Commission, Department of Surgical Specialties and Anaesthesiology, Botucatu Medical School, Sao Paulo State University - UNESP, Botucatu, SP, Brazil
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Fielding-Singh V, Willingham MD, Fischer MA, Grogan T, Benharash P, Neelankavil JP. A Population-Based Analysis of Intraoperative Cardiac Arrest in the United States. Anesth Analg 2020; 130:627-634. [DOI: 10.1213/ane.0000000000004477] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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10
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Predictors and their prognostic value for no ROSC and mortality after a non-cardiac surgery intraoperative cardiac arrest: a retrospective cohort study. Sci Rep 2019; 9:14975. [PMID: 31628390 PMCID: PMC6802384 DOI: 10.1038/s41598-019-51557-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2019] [Accepted: 10/01/2019] [Indexed: 01/10/2023] Open
Abstract
Data on predictors of intraoperative cardiac arrest (ICA) outcomes are scarce in the literature. This study analysed predictors of poor outcome and their prognostic value after an ICA. Clinical and laboratory data before and 24 hours (h) after ICA were analysed as predictors for no return of spontaneous circulation (ROSC) and 24 h and 1-year mortality. Receiver operating characteristic curves for each predictor and sensitivity, specificity, positive and negative likelihood ratios, and post-test probability were calculated. A total of 167,574 anaesthetic procedures were performed, including 158 cases of ICAs. Based on the predictors for no ROSC, a threshold of 13 minutes of ICA yielded the highest area under curve (AUC) (0.867[0.80–0.93]), with a sensitivity and specificity of 78.4% [69.6–86.3%] and 89.3% [80.4–96.4%], respectively. For the 1-year mortality, the GCS without the verbal component 24 h after an ICA had the highest AUC (0.616 [0.792–0.956]), with a sensitivity of 79.3% [65.5–93.1%] and specificity of 86.1 [74.4–95.4]. ICA duration and GCS 24 h after the event had the best prognostic value for no ROSC and 1-year mortality. For 24 h mortality, no predictors had prognostic value.
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Min JJ, Tay CK, Ryu DK, Wi W, Sung K, Lee YT, Cho YH, Lee JH. Extracorporeal cardiopulmonary resuscitation in refractory intra-operative cardiac arrest: an observational study of 12-year outcomes in a single tertiary hospital. Anaesthesia 2018; 73:1515-1523. [DOI: 10.1111/anae.14412] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/03/2018] [Indexed: 11/30/2022]
Affiliation(s)
- J. J. Min
- Department of Anaesthesiology and Pain Medicine; Department of Thoracic and Cardiovascular Surgery; Samsung Medical Centre; Sungkyukwan University School of Medicine; Seoul Korea
| | - C. K. Tay
- Department of Respiratory and Critical Care; Singapore General Hospital; Singapore
| | - D. K. Ryu
- Department of Anaesthesiology and Pain Medicine; Department of Thoracic and Cardiovascular Surgery; Samsung Medical Centre; Sungkyukwan University School of Medicine; Seoul Korea
| | - W. Wi
- Department of Anaesthesiology and Pain Medicine; Department of Thoracic and Cardiovascular Surgery; Samsung Medical Centre; Sungkyukwan University School of Medicine; Seoul Korea
| | - K. Sung
- Department of Thoracic and Cardiovascular Surgery; Samsung Medical Centre; Sungkyukwan University School of Medicine; Seoul Korea
| | - Y. T. Lee
- Department of Thoracic and Cardiovascular Surgery; Samsung Medical Centre; Sungkyukwan University School of Medicine; Seoul Korea
| | - Y. H. Cho
- Department of Thoracic and Cardiovascular Surgery; Samsung Medical Centre; Sungkyukwan University School of Medicine; Seoul Korea
| | - J.-H. Lee
- Department of Anaesthesiology and Pain Medicine; Department of Thoracic and Cardiovascular Surgery; Samsung Medical Centre; Sungkyukwan University School of Medicine; Seoul Korea
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12
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Welbourn C, Efstathiou N. How does the length of cardiopulmonary resuscitation affect brain damage in patients surviving cardiac arrest? A systematic review. Scand J Trauma Resusc Emerg Med 2018; 26:77. [PMID: 30201018 PMCID: PMC6131783 DOI: 10.1186/s13049-018-0476-3] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2017] [Accepted: 01/03/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Brain injury can occur after cardiac arrest due to the effects of ischaemia and reperfusion. In serious cases this can lead to permanent disability. This risk must be considered when making decisions about terminating resuscitation. There are very specific rules for termination of resuscitation in the prehospital setting however a similar rule for resuscitation in hospital does not exist. The aim of this review was to explore the effects of duration of cardiopulmonary resuscitation on neurological outcome in survivors of both in-hospital and out-of-hospital cardiac arrest achieving return of spontaneous circulation in hospital. METHODS A systematic review was conducted. Five databases were searched in addition to hand searching the journals Resuscitation and Circulation and reference lists, quality of the selected studies was assessed and a narrative summary of the data presented. Studies reporting relevant outcomes were included if the participants were adults achieving return of spontaneous circulation in the hospital setting. Studies looking at additional interventions such as extracorporeal resuscitation and therapeutic hypothermia were not included. Case studies were excluded. The study period was from January 2010 to March 2016. RESULTS Seven cohort studies were included for review. Quality scores ranged from eight to 11 out of 12. Five of the studies found a significant association between shorter duration of resuscitation and favourable neurological outcome. CONCLUSIONS There is generally a better neurological outcome with a shorter duration of CPR in survivors of cardiac arrest however a cut-off beyond which resuscitation is likely to lead to unfavourable outcome could not be determined and is unlikely to exist. The findings of this review could be considered by clinicians making decisions about terminating resuscitation. This review has highlighted many gaps in the knowledge where future research is needed; a validated and reliable measure of neurological outcome following cardiac arrest, more focused research on the effects of duration on neurological outcome and further research into the factors leading to brain damage in cardiac arrest.
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Affiliation(s)
- Clare Welbourn
- College of Medical and Dental Sciences, University of Birmingham, Edgbaston, Birmingham B15 2TT UK
| | - Nikolaos Efstathiou
- College of Medical and Dental Sciences, Institute of Clinical Sciences, School of Nursing, Medical School, University of Birmingham, Room EF15, Vincent Drive, Birmingham, B15 2TT UK
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13
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Neurological prognosis of 6 cases after chest compression during general anesthesia. J Anesth 2018; 32:259-262. [DOI: 10.1007/s00540-018-2449-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2017] [Accepted: 01/06/2018] [Indexed: 10/18/2022]
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14
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Hur M, Lee HC, Lee KH, Kim JT, Jung CW, Park HP. The incidence and characteristics of 3-month mortality after intraoperative cardiac arrest in adults. Acta Anaesthesiol Scand 2017; 61:1095-1104. [PMID: 28799206 DOI: 10.1111/aas.12955] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2017] [Revised: 07/20/2017] [Accepted: 07/22/2017] [Indexed: 12/15/2022]
Abstract
BACKGROUND There is little information about clinical outcomes after intraoperative cardiac arrest (IOCA). We determined the incidence and characteristics of 3-month mortality after IOCA. METHODS The electronic medical records of 238,648 adult surgical patients from January 2005 to December 2014 were reviewed retrospectively. Characteristics of IOCA were documented using the Utstein reporting template. RESULTS IOCA occurred in 50 patients (21/100,000 surgeries). Nineteen patients died in the operating room, and further 12 patients died within 3 months post-arrest (total mortality: 62%). Three survivors at 3 months post-arrest had unfavourable neurological outcome. Finally, 34 patients showed unfavourable clinical outcomes at 3 months post-arrest. The incidences of non-cardiac surgery, emergency, pre-operative intubation state, non-shockable initial cardiac rhythm, hypovolaemic shock, pre-operative complications-induced cardiac arrest, non-anaesthetic cause of cardiac arrest, intra- and post-arrest transfusion, and continuous infusion of inotrope or vasopressor in intensive care unit (ICU) were significantly higher in non-survivors at 3 months post-arrest. Total epinephrine dose administrated during arrest was higher, and the duration of cardiac compressions was longer in non-survivors at 3 months post-arrest. CONCLUSIONS In this study, the incidence of IOCA was 21/100,000 surgeries and the 3-month mortality rate after IOCA was 62%. Several factors including surgical emergency, non-shockable initial cardiac rhythm, pre-operative complications, surgical complications, long duration of cardiac compressions, high total epinephrine dose, transfusion, and continuous infusion of inotropes or vasopressors in ICU seemed to be risk factors for 3-month mortality after IOCA. These risk factors should be considered in the light of relatively small sample size of this study.
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Affiliation(s)
- M. Hur
- Department of Anaesthesiology and Pain Medicine; Seoul National University Hospital; Seoul National University College of Medicine; Seoul Korea
| | - H.-C. Lee
- Department of Anaesthesiology and Pain Medicine; Seoul National University Hospital; Seoul National University College of Medicine; Seoul Korea
| | - K. H. Lee
- Department of Anaesthesiology and Pain Medicine; Seoul National University Hospital; Seoul National University College of Medicine; Seoul Korea
| | - J.-T. Kim
- Department of Anaesthesiology and Pain Medicine; Seoul National University Hospital; Seoul National University College of Medicine; Seoul Korea
| | - C.-W. Jung
- Department of Anaesthesiology and Pain Medicine; Seoul National University Hospital; Seoul National University College of Medicine; Seoul Korea
| | - H.-P. Park
- Department of Anaesthesiology and Pain Medicine; Seoul National University Hospital; Seoul National University College of Medicine; Seoul Korea
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15
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Xu DJ, Wang B, Zhao X, Zheng Y, Du JL, Wang YW. General anesthetics protects against cardiac arrest-induced brain injury by inhibiting calcium wave propagation in zebrafish. Mol Brain 2017; 10:44. [PMID: 28870222 PMCID: PMC5583756 DOI: 10.1186/s13041-017-0323-x] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2017] [Accepted: 08/23/2017] [Indexed: 12/23/2022] Open
Abstract
Cardiac arrest is a leading cause of death and disability worldwide. Although many victims are initially resuscitated, they often suffer from serious brain injury, even leading to a “persistent vegetative state”. Therefore, it is need to explore therapies which restore and protect brain function after cardiac arrest. In the present study, using Tg (HuC:GCaMP5) zebrafish as a model, we found the zebrafish brain generated a burst of Ca2+ wave after cardiac arrest by in vivo time-lapse confocal imaging. The Ca2+ wave was firstly initiated at hindbrain and then sequentially propagated to midbrain and telencephalon, the neuron displayed Ca2+ overload after Ca2+ wave propagation. Consistent with this, our study further demonstrated neuronal apoptosis was increased in cardiac arrest zebrafish by TUNEL staining. The cardiac arrest-induced Ca2+ wave propagation can be prevented by general anesthetics such as midazolam or ketamine pretreatment. Moreover, midazolam or ketamine pretreatment dramatically decreased the neuronal apoptosis and improved the survival rate in CA zebrafish. Taken together, these findings provide the first in vivo evidence that general anesthetics pretreatment protects against cardiac arrest-induced brain injury by inhibiting calcium wave propagation in zebrafish.
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Affiliation(s)
- Dao-Jie Xu
- Department of Anesthesiology, Xinhua Hospital, Medical School, Shanghai Jiaotong University, 1665 Kong-Jiang Road, Shanghai, 200092, China
| | - Bin Wang
- Department of Anesthesiology, Xinhua Hospital, Medical School, Shanghai Jiaotong University, 1665 Kong-Jiang Road, Shanghai, 200092, China
| | - Xuan Zhao
- Department of Anesthesiology, Xinhua Hospital, Medical School, Shanghai Jiaotong University, 1665 Kong-Jiang Road, Shanghai, 200092, China
| | - Yi Zheng
- Department of Anesthesiology, Xinhua Hospital, Medical School, Shanghai Jiaotong University, 1665 Kong-Jiang Road, Shanghai, 200092, China
| | - Jiu-Lin Du
- Institute of Neuroscience, State Key Laboratory of Neuroscience, Center for Excellence in Brain Science and Intelligence Technology Chinese Academy of Sciences, Shanghai, 200031, China
| | - Ying-Wei Wang
- Department of Anesthesiology, Huashan Hospital, Fudan University, No. 12 Wu lu mu qi Road, Shanghai, 200040, China.
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16
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Han F, Wang Y, Wang Y, Dong J, Nie C, Chen M, Hou L. Intraoperative cardiac arrest: A 10-year study of patients undergoing tumorous surgery in a tertiary referral cancer center in China. Medicine (Baltimore) 2017; 96:e6794. [PMID: 28445319 PMCID: PMC5413284 DOI: 10.1097/md.0000000000006794] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
Abstract
Intraoperative cardiac arrest (IOCA) is a lethal complication of noncardiac surgery. According to several reports, immediate survival after IOCA is approximately 50%. In this study, a retrospective case analysis was performed to determine the incidence of IOCA, the potential causes of cardiac arrest, and the risk factors of no resuscitation in patients undergoing tumorous surgery.The medical records of surgery patients who experienced cardiac arrest during the intraoperative period between 2005 and 2014 were reviewed. The general conditions of the patients with IOCA were compared between the successfully resuscitated group and the unresuscitated group.Fifteen patients with IOCA among 142,853 patients undergoing tumorous surgery were reviewed during the study period. Immediate survival after IOCA was 60%. Hospital survival was 46.7%. The incidence of IOCA decreased during 2010 to 2014 when compared with the rate during 2005 to 2009 (P < .05). The risk factors affecting the success of resuscitation after IOCA included American Society of Anesthesiologists Physical Status (ASA PS) classification ≥ III (P < .05) and preoperative tachycardia (heart rate ≥100/min, P < .05). The methods of anesthesia had no effects on the results of resuscitation.The incidence of IOCA in patients undergoing tumorous surgery was 1.05 per 10,000 anesthesia. The overall mortality of IOCA was 0.56/10,000. The frequency of IOCA decreased within 10 years. There was no cardiac arrest primarily attributable to anesthesia over this study period. The risk factors leading to unsuccessful resuscitation after IOCA were ASA PS classification ≥ III and preoperative tachycardia.
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17
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Constant AL, Mongardon N, Morelot Q, Pichon N, Grimaldi D, Bordenave L, Soummer A, Sauneuf B, Merceron S, Ricome S, Misset B, Bruel C, Schnell D, Boisramé-Helms J, Dubuisson E, Brunet J, Lasocki S, Cronier P, Bouhemad B, Carreira S, Begot E, Vandenbunder B, Dhonneur G, Jullien P, Resche-Rigon M, Bedos JP, Montlahuc C, Legriel S. Targeted temperature management after intraoperative cardiac arrest: a multicenter retrospective study. Intensive Care Med 2017; 43:485-495. [PMID: 28220232 DOI: 10.1007/s00134-017-4709-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2016] [Accepted: 01/31/2017] [Indexed: 12/21/2022]
Abstract
PURPOSE Few outcome data are available about temperature management after intraoperative cardiac arrest (IOCA). We describe targeted temperature management (TTM) (32-34 °C) modalities, adverse events, and association with 1-year functional outcome in patients with IOCA. METHODS Patients admitted to 11 ICUs after IOCA in 2008-2013 were studied retrospectively. The main outcome measure was 1-year functional outcome. RESULTS Of the 101 patients [35 women and 66 men; median age, 62 years (interquartile range, 42-72)], 68 (67.3%) were ASA PS I to III and 57 (56.4%) had emergent surgery. First recorded rhythms were asystole in 44 (43.6%) patients, pulseless electrical activity in 36 (35.6%), and ventricular fibrillation/tachycardia in 20 (19.8%). Median times from collapse to cardiopulmonary resuscitation and return of spontaneous circulation (ROSC) were 0 min (0-0) and 10 min (4-20), respectively. The 30 (29.7%) patients who received TTM had an increased risk of infection (P = 0.005) but not of arrhythmia, bleeding, or metabolic/electrolyte disorders. By multivariate analysis, one or more defibrillation before ROSC was positively associated with a favorable functional outcome at 1-year (OR 3.06, 95% CI 1.05-8.95, P = 0.04) and emergency surgery was negatively associated with 1-year favorable functional outcome (OR 0.36; 95% CI 0.14-0.95, P = 0.038). TTM use was not independently associated with 1-year favorable outcome (OR 0.82; 95% CI 0.27-2.46, P = 0.72). CONCLUSIONS TTM was used in less than one-third of patients after IOCA. TTM was associated with infection but not with bleeding or coronary events in this setting. TTM did not independently predict 1-year favorable functional outcome after IOCA in this study.
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Affiliation(s)
- Anne-Laure Constant
- Medical-Surgical Intensive Care Unit, Intensive Care Department, Centre Hospitalier de Versailles-Site André Mignot, 177 rue de Versailles, 78150, Le Chesnay Cedex, France.,Department of Anesthesiology and Critical Care Medicine, Hôpital Européen Georges Pompidou, 75015, Paris, France
| | - Nicolas Mongardon
- Department of Anesthesiology and Surgical Intensive Care Units, Hôpital Henri Mondor, Assistance Publique des Hôpitaux de Paris, 51 avenue du Maréchal de Lattre de Tassigny, 94000, Créteil, France.,Faculté de médecine, Université Paris Est, 8 avenue du général Sarrail, 94000, Créteil, France.,Inserm, U955, Equipe 3 "Stratégies pharmacologiques et thérapeutiques expérimentales des insuffisances cardiaques et coronaires", 8 avenue du général Sarrail, Créteil, France
| | - Quentin Morelot
- SBIM Biostatistics and Medical information, Hôpital Saint-Louis, APHP, 1, avenue Claude Vellefaux, Paris, France.,Université Paris Diderot, Paris, France.,ECSTRA Team (Epidémiologie Clinique et Statistiques pour la Recherche en Santé), UMR 1153 INSERM, Université Paris Diderot, Sorbonne Paris Cité, Paris, France
| | - Nicolas Pichon
- Medical-Surgical Intensive Care Unit, Centre Hospitalier Universitaire de Limoges, 2, avenue Martin-Luther-King, 87042, Limoges, France
| | - David Grimaldi
- Medical-Surgical Intensive Care Unit, Intensive Care Department, Centre Hospitalier de Versailles-Site André Mignot, 177 rue de Versailles, 78150, Le Chesnay Cedex, France
| | - Lauriane Bordenave
- Department of Anesthesiology, Institut Gustave Roussy, 39, rue Camille-Desmoulins, 94805, Villejuif Cedex, France
| | - Alexis Soummer
- Department of Intensive Care Medicine, Foch Hospital, 40 rue Worth, 92150, Suresnes, France
| | - Bertrand Sauneuf
- Pôle Anesthésie-Réanimation-SAMU, CHU de Caen, Avenue de la côte de Nacre, CS30001, 14033, Caen Cedex 9, France
| | - Sybille Merceron
- Medical-Surgical Intensive Care Unit, Intensive Care Department, Centre Hospitalier de Versailles-Site André Mignot, 177 rue de Versailles, 78150, Le Chesnay Cedex, France
| | - Sylvie Ricome
- Department of Anesthesiology and Critical Care, Assistance Publique des Hôpitaux de Paris, 100 boulevard du Général-Leclerc, 92110, Clichy la Garenne, France
| | - Benoit Misset
- Medical-Surgical Intensive Care Unit, Groupe Hospitalier Saint Joseph, 185 rue Raymond Losserand, 75614, Paris Cedex, France.,Sorbonne Paris Cité-Medical School, Paris Descartes University, Paris, France
| | - Cedric Bruel
- Medical-Surgical Intensive Care Unit, Groupe Hospitalier Saint Joseph, 185 rue Raymond Losserand, 75614, Paris Cedex, France
| | - David Schnell
- Medical Intensive Care Unit, Nouvel Hôpital Civil, Hôpitaux Universitaires de Strasbourg, Strasbourg, France
| | - Julie Boisramé-Helms
- Medical Intensive Care Unit, Nouvel Hôpital Civil, Hôpitaux Universitaires de Strasbourg, Strasbourg, France.,EA 7293, Fédération de Médecine Translationnelle de Strasbourg (FMTS), Faculté de médecine, Université de Strasbourg, Strasbourg, France
| | - Etienne Dubuisson
- Department of Anesthesiology, Centre Hospitalier de Versailles-Site André Mignot, 177 rue de Versailles, 78150, Le Chesnay Cedex, France
| | - Jennifer Brunet
- Pôle Anesthésie-Réanimation-SAMU, CHU de Caen, Avenue de la côte de Nacre, CS30001, 14033, Caen Cedex 9, France
| | - Sigismond Lasocki
- Pôle d'Anesthésie Réanimation, CHU d'Angers, 4 rue Larrey, 49933, Angers Cedex 9, Angers, France.,LUNAM Université, CHU d'Angers, 49933, Angers Cedex, France
| | - Pierrick Cronier
- Intensive Care Unit, Centre Hospitalier Sud-Francilien, 116 boulevard Jean Jaurès, 91106, Corbeil-Essonnes Cedex, France
| | - Belaid Bouhemad
- Department of Anesthesiology and Critical Care, Groupe Hospitalier Saint Joseph, 185 rue Raymond Losserand, 75614, Paris Cedex, France
| | - Serge Carreira
- Department of Intensive Care Medicine, Hôpital Saint-Camill, 2 rue des Pères-Camiliens, 94360, Bry-sur-Marne, France
| | - Emmanuelle Begot
- Medical-Surgical Intensive Care Unit, Centre Hospitalier Universitaire de Limoges, 2, avenue Martin-Luther-King, 87042, Limoges, France
| | - Benoit Vandenbunder
- Department of Anesthesiology, Foch Hospital, 40 rue Worth, 92150, Suresnes, France
| | - Gilles Dhonneur
- Department of Anesthesiology and Surgical Intensive Care Units, Hôpital Henri Mondor, Assistance Publique des Hôpitaux de Paris, 51 avenue du Maréchal de Lattre de Tassigny, 94000, Créteil, France.,Faculté de médecine, Université Paris Est, 8 avenue du général Sarrail, 94000, Créteil, France
| | - Philippe Jullien
- Department of Anesthesiology, Centre Hospitalier de Versailles-Site André Mignot, 177 rue de Versailles, 78150, Le Chesnay Cedex, France
| | - Matthieu Resche-Rigon
- SBIM Biostatistics and Medical information, Hôpital Saint-Louis, APHP, 1, avenue Claude Vellefaux, Paris, France.,Université Paris Diderot, Paris, France.,ECSTRA Team (Epidémiologie Clinique et Statistiques pour la Recherche en Santé), UMR 1153 INSERM, Université Paris Diderot, Sorbonne Paris Cité, Paris, France
| | - Jean-Pierre Bedos
- Medical-Surgical Intensive Care Unit, Intensive Care Department, Centre Hospitalier de Versailles-Site André Mignot, 177 rue de Versailles, 78150, Le Chesnay Cedex, France
| | - Claire Montlahuc
- SBIM Biostatistics and Medical information, Hôpital Saint-Louis, APHP, 1, avenue Claude Vellefaux, Paris, France.,Université Paris Diderot, Paris, France.,ECSTRA Team (Epidémiologie Clinique et Statistiques pour la Recherche en Santé), UMR 1153 INSERM, Université Paris Diderot, Sorbonne Paris Cité, Paris, France
| | - Stephane Legriel
- Medical-Surgical Intensive Care Unit, Intensive Care Department, Centre Hospitalier de Versailles-Site André Mignot, 177 rue de Versailles, 78150, Le Chesnay Cedex, France. .,Sorbonne Paris Cité-Medical School, Paris Descartes University, Paris, France. .,INSERM U970, Paris Cardiovascular Research Center, Paris, France.
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18
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Abstract
Abstract
Automatic suspension of do-not-resuscitate (DNR) orders during general anesthesia does not sufficiently address a patient’s right to self-determination and is a practice still observed among anesthesiologists today. To provide an evidence base for ethical management of DNR orders during anesthesia and surgery, the authors performed a systematic review of the literature to quantify the survival after perioperative cardiopulmonary resuscitation (CPR). Results show that the probability of surviving perioperative CPR ranged from 32.0 to 55.7% when measured within the first 24 h after arrest with a neurologically favorable outcome expectancy between 45.3 and 66.8% at follow-up, which suggests a viable survival of approximately 25%. Because CPR generally proves successful in less than 15% of out-of-hospital cardiac arrests, the altered outcome probabilities that the conditions in the operating room bring on warrant reevaluation of DNR orders during the perioperative period. By preoperatively communicating the evidence to patients, they can make better informed decisions while reducing the level of moral distress that anesthesiologists may experience when certain patients decide to retain their DNR orders.
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19
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Machuca TN, Cypel M, Keshavjee S. Cardiopulmonary Bypass and Extracorporeal Life Support for Emergent Intraoperative Thoracic Situations. Thorac Surg Clin 2016. [PMID: 26210928 DOI: 10.1016/j.thorsurg.2015.04.012] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
Intraoperative thoracic surgical catastrophes may require extracorporeal circulation modes to support the patient while the appropriate repair is made. Teamwork is key and, given the evidence supporting better performance with the use of simulation and surgical-crisis checklists, their use should be encouraged. Anticipation is another important factor because the results of intrathoracic malignancy resection are clearly superior in the setting of planned cardiopulmonary support. In addition, familiarity with the different modes of support that are currently available can direct the decision-making process toward the best option to facilitate resolution of the intraoperative catastrophe with the least related morbidity.
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Affiliation(s)
- Tiago N Machuca
- Division of Thoracic Surgery, Toronto General Hospital, University Health Network, University of Toronto, 200 Elizabeth Street, 9N-946, Toronto, Ontario M5G 2C4, Canada
| | - Marcelo Cypel
- Division of Thoracic Surgery, Toronto General Hospital, University Health Network, University of Toronto, 200 Elizabeth Street, 9N-946, Toronto, Ontario M5G 2C4, Canada
| | - Shaf Keshavjee
- Division of Thoracic Surgery, Toronto General Hospital, University Health Network, University of Toronto, 200 Elizabeth Street, 9N-946, Toronto, Ontario M5G 2C4, Canada.
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20
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Abstract
A healthy, active duty military 25-year-old female with a history of congenital complete heart block presented for a routine septorhinoplasty. During the preoperative interview, she did not disclose her heart condition. A preordered electrocardiogram was not available. During induction of anesthesia, she became extremely bradycardic, approaching asystole, requiring resuscitation. This case highlights the potential anesthetic risks in individuals with a history of congenital heart rhythm disease.
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21
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Champigneulle B, Merceron S, Lemiale V, Geri G, Mokart D, Bruneel F, Vincent F, Perez P, Mayaux J, Cariou A, Azoulay E. What is the outcome of cancer patients admitted to the ICU after cardiac arrest? Results from a multicenter study. Resuscitation 2015; 92:38-44. [DOI: 10.1016/j.resuscitation.2015.04.011] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2015] [Revised: 04/06/2015] [Accepted: 04/11/2015] [Indexed: 11/30/2022]
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