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Ueno R, Chan R, Reddy MP, Jones D, Pilcher D, Subramaniam A. Long-term survival comparison of patients admitted to the intensive care unit following in-hospital cardiac arrest in perioperative and ward settings. A multicentre retrospective cohort study. Intensive Care Med 2024; 50:1496-1505. [PMID: 39115566 DOI: 10.1007/s00134-024-07570-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2024] [Accepted: 07/23/2024] [Indexed: 09/06/2024]
Abstract
PURPOSE Perioperative in-hospital cardiac arrests (Perioperative IHCAs) may have better outcomes than IHCAs in the ward (Ward IHCAs), due to enhanced monitoring and faster response. However, quantitative comparisons of their long-term outcomes are lacking, posing challenges for prognostication. METHODS This retrospective multicentre study included adult intensive care unit (ICU) admissions from theatre/recovery or wards with a diagnosis of cardiac arrest between January 2018 and March 2022. We used data from 175 ICUs in the ANZICS adult patient database. The primary outcome was a survival time of up to 4 years. We used the Cox proportional hazards model adjusted for Sequential Organ Failure Assessment (SOFA) score, age, sex, comorbidities, hospital type, treatment limitation on admission to the ICU, and ICU treatments. Subgroup analyses examined age (≥ 65 years), intubation within the first 24 h, elective vs. emergency admission, and survival on discharge. RESULTS Of 702,675 ICU admissions, 5,659 IHCAs were included (Perioperative IHCA 38%; Ward IHCA 62%). Perioperative IHCA group were younger, less frail, and less comorbid. Perioperative IHCA were most frequent in patients admitted to ICU after cardiovascular, gastrointestinal, or trauma surgeries. Perioperative IHCA group had longer 4-year survival (59.9% vs. 33.0%, p < 0.001) than the Ward IHCA group, even after adjustments (adjusted hazard ratio [HR]: 0.63, 95% confidence interval [CI] 0.57-0.69). This was concordant across all subgroups. Of note, older patients with Perioperative IHCA survived longer than both younger and older patients with Ward IHCA. CONCLUSION Patients admitted to the ICU following Perioperative IHCA had longer survival than Ward IHCA. Future studies on IHCA should distinguish these patients.
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Affiliation(s)
- Ryo Ueno
- Department of Intensive Care, Box Hill Hospital, Eastern Health, Box Hill, VIC, Australia.
- Department of Epidemiology and Preventive Medicine, Australian and New Zealand Intensive Care Research Centre, Monash University, Melbourne, VIC, Australia.
- Department of Intensive Care, Austin Health, Heidelberg, VIC, Australia.
| | - Rachel Chan
- Department of Anaesthesia and Pain Medicine, The Canberra Hospital, Canberra, Australia
| | - Mallikarjuna Ponnapa Reddy
- Department of Anaesthesia and Pain Medicine, Nepean Hospital, Sydney, NSW, Australia
- Department of Intensive Care, Peninsula Health, Frankston, VIC, Australia
- Department of Intensive Care, North Canberra Hospital, Canberra, Australia
| | - Daryl Jones
- Department of Epidemiology and Preventive Medicine, Australian and New Zealand Intensive Care Research Centre, Monash University, Melbourne, VIC, Australia
- Department of Intensive Care, Austin Health, Heidelberg, VIC, Australia
- University of Melbourne, Parkville, VIC, Australia
| | - David Pilcher
- Department of Epidemiology and Preventive Medicine, Australian and New Zealand Intensive Care Research Centre, Monash University, Melbourne, VIC, Australia
- Centre for Outcome and Resource Evaluation, Australian and New Zealand Intensive Care Society, Melbourne, VIC, Australia
- Department of Intensive Care, Alfred Hospital, Melbourne, VIC, Australia
| | - Ashwin Subramaniam
- Department of Epidemiology and Preventive Medicine, Australian and New Zealand Intensive Care Research Centre, Monash University, Melbourne, VIC, Australia
- Department of Intensive Care, Peninsula Health, Frankston, VIC, Australia
- Department of Intensive Care, Dandenong Hospital, Dandenong, VIC, Australia
- Peninsula Clinical School, Monash University, Frankston, VIC, Australia
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You Y, Gong Z, Zhang Y, Qiu L, Tang X. Observation of the effect of hypothermia therapy combined with optimized nursing on brain protection after cardiopulmonary resuscitation: A retrospective case-control study. Medicine (Baltimore) 2024; 103:e37776. [PMID: 38640316 PMCID: PMC11029950 DOI: 10.1097/md.0000000000037776] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2023] [Revised: 12/20/2023] [Accepted: 03/12/2024] [Indexed: 04/21/2024] Open
Abstract
This study aimed to investigate the impact of optimized emergency nursing in conjunction with mild hypothermia nursing on neurological prognosis, hemodynamics, and complications in patients with cardiac arrest. A retrospective analysis was conducted on the medical records of 124 patients who received successful cardiopulmonary resuscitation (CPR) at Fujian Provincial Hospital South Branch. The patients were divided into control and observation groups, each consisting of 62 cases. The brain function of both groups was assessed using the Glasgow Coma Scale and the National Institutes of Health Stroke Scale. Additionally, serum neuron-specific enolase level was measured in both groups. The vital signs and hemodynamics of both groups were analyzed, and the complications and satisfaction experienced by the 2 groups were compared. The experimental group exhibited significantly improved neurological function than the control group (P < .05). Furthermore, the heart rate in the experimental group was significantly lower than the control group (P < .05). However, no significant differences were observed in blood oxygen saturation, mean arterial pressure, central venous pressure, and systolic blood pressure between the 2 groups (P > 0.05). Moreover, the implementation of optimized nursing practices significantly reduced complications and improved the quality of life and satisfaction of post-CPR patients (P < .05). The integration of optimized emergency nursing practices in conjunction with CPR improves neurological outcomes in patients with cardiac arrest.
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Affiliation(s)
- Yan You
- The Second Department of Intensive Care Unit, Fujian Provincial Hospital South Branch, Fuzhou, China
| | - Zheng Gong
- Department of Emergency Medicine, Fujian Provincial Hospital, Fuzhou, China
- Shengli Clinical Medical College of Fujian Medical University, Fujian Medical University, Fuzhou, China
- Fujian Provincial Key Laboratory of Emergency Medicine, Fuzhou, China
| | - Yaxu Zhang
- The Second Department of Intensive Care Unit, Fujian Provincial Hospital South Branch, Fuzhou, China
| | - Lirong Qiu
- The Second Department of Intensive Care Unit, Fujian Provincial Hospital South Branch, Fuzhou, China
| | - Xiahong Tang
- Department of Critical Care Medicine, The Affiliated People’s Hospital of Fujian University of Traditional Chinese Medicine, Fuzhou, China
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Kane AD, Cook TM, Armstrong RA, Kursumovic E, Davies MT, Agarwal S, Nolan JP, Smith JH, Moppett IK, Oglesby FC, Cortes L, Taylor C, Cordingley J, Dorey J, Finney SJ, Kunst G, Lucas DN, Nickols G, Mouton R, Patel B, Pappachan VJ, Plaat F, Scholefield BR, Varney L, Soar J. The incidence of potentially serious complications during non-obstetric anaesthetic practice in the United Kingdom: an analysis from the 7th National Audit Project (NAP7) activity survey. Anaesthesia 2024; 79:43-53. [PMID: 37944508 DOI: 10.1111/anae.16155] [Citation(s) in RCA: 14] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/08/2023] [Indexed: 11/12/2023]
Abstract
Complications and critical incidents arising during anaesthesia due to patient, surgical or anaesthetic factors, may cause harm themselves or progress to more severe events, including cardiac arrest or death. As part of the 7th National Audit Project of the Royal College of Anaesthetists, we studied a prospective national cohort of unselected patients. Anaesthetists recorded anonymous details of all cases undertaken over 4 days at their site through an online survey. Of 416 hospital sites invited to participate, 352 (85%) completed the survey. Among 24,172 cases, 1922 discrete potentially serious complications were reported during 1337 (6%) cases. Obstetric cases had a high reported major haemorrhage rate and were excluded from further analysis. Of 20,996 non-obstetric cases, 1705 complications were reported during 1150 (5%) cases. Circulatory events accounted for most complications (616, 36%), followed by airway (418, 25%), metabolic (264, 15%), breathing (259, 15%), and neurological (41, 2%) events. A single complication was reported in 851 (4%) cases, two complications in 166 (1%) cases and three or more complications in 133 (1%) cases. In non-obstetric elective surgery, all complications were 'uncommon' (10-100 per 10,000 cases). Emergency (urgent and immediate priority) surgery accounted for 3454 (16%) of non-obstetric cases but 714 (42%) of complications with severe hypotension, major haemorrhage, severe arrhythmias, septic shock, significant acidosis and electrolyte disturbances all being 'common' (100-1000 per 10,000 cases). Based on univariate analysis, complications were associated with: younger age; higher ASA physical status; male sex; increased frailty; urgency and extent of surgery; day of the week; and time of day. These data represent the rates of potentially serious complications during routine anaesthesia care and may be valuable for risk assessment and patient consent.
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Armstrong RA, Soar J, Kane AD, Kursumovic E, Nolan JP, Oglesby FC, Cortes L, Taylor C, Moppett IK, Agarwal S, Cordingley J, Davies MT, Dorey J, Finney SJ, Kendall S, Kunst G, Lucas DN, Mouton R, Nickols G, Pappachan VJ, Patel B, Plaat F, Scholefield BR, Smith JH, Varney L, Wain E, Cook TM. Peri-operative cardiac arrest: epidemiology and clinical features of patients analysed in the 7th National Audit Project of the Royal College of Anaesthetists. Anaesthesia 2024; 79:18-30. [PMID: 37972476 DOI: 10.1111/anae.16156] [Citation(s) in RCA: 17] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/22/2023] [Indexed: 11/19/2023]
Abstract
The 7th National Audit Project of the Royal College of Anaesthetists studied peri-operative cardiac arrest in the UK, a topic of importance to patients, anaesthetists and surgeons. Here we report the results of the 12-month registry, from 16 June 2021 to 15 June 2022, focusing on epidemiology and clinical features. We reviewed 881 cases of peri-operative cardiac arrest, giving an incidence of 3 in 10,000 anaesthetics (95%CI 3.0-3.5 per 10,000). Incidence varied with patient and surgical factors. Compared with denominator survey activity, patients with cardiac arrest: included more males (56% vs. 42%); were older (median (IQR) age 60.5 (40.5-80.5) vs. 50.5 (30.5-70.5) y), although the age distribution was bimodal, with infants and patients aged > 66 y overrepresented; and were notably more comorbid (73% ASA physical status 3-5 vs. 27% ASA physical status 1-2). The surgical case-mix included more weekend (14% vs. 11%), out-of-hours (19% vs. 10%), non-elective (65% vs. 30%) and major/complex cases (60% vs. 28%). Cardiac arrest was most prevalent in orthopaedic trauma (12%), lower gastrointestinal surgery (10%), cardiac surgery (9%), vascular surgery (8%) and interventional cardiology (6%). Specialities with the highest proportion of cases relative to denominator activity were: cardiac surgery (9% vs. 1%); cardiology (8% vs. 1%); and vascular surgery (8% vs. 2%). The most common causes of cardiac arrest were: major haemorrhage (17%); bradyarrhythmia (9%); and cardiac ischaemia (7%). Patient factors were judged a key cause of cardiac arrest in 82% of cases, anaesthesia in 40% and surgery in 35%.
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Armstrong RA, Cook TM, Kane AD, Kursumovic E, Nolan JP, Oglesby FC, Cortes L, Taylor C, Moppett IK, Agarwal S, Cordingley J, Davies MT, Dorey J, Finney SJ, Kendall S, Kunst G, Lucas DN, Mouton R, Nickols G, Pappachan VJ, Patel B, Plaat F, Scholefield BR, Smith JH, Varney L, Wain E, Soar J. Peri-operative cardiac arrest: management and outcomes of patients analysed in the 7th National Audit Project of the Royal College of Anaesthetists. Anaesthesia 2024; 79:31-42. [PMID: 37972480 DOI: 10.1111/anae.16157] [Citation(s) in RCA: 14] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/28/2023] [Indexed: 11/19/2023]
Abstract
The 7th National Audit Project of the Royal College of Anaesthetists studied peri-operative cardiac arrest in the UK, a topic of importance to patients, anaesthetists and surgeons. We report the results of the 12-month registry phase, from 16 June 2021 to 15 June 2022, focusing on management and outcomes. Among 881 cases of peri-operative cardiac arrest, the initial rhythm was non-shockable in 723 (82%) cases, most commonly pulseless electrical activity. There were 665 (75%) patients who survived the initial event and 384 (52%) who survived to hospital discharge. A favourable functional outcome (based on modified Rankin Scale score) was reported for 249 (88%) survivors. Outcomes varied according to arrest rhythm. The highest rates of survival were seen for bradycardic cardiac arrests with 111 (86%) patients surviving the initial event and 77 (60%) patients surviving the hospital episode. The lowest survival rates were seen for patients with pulseless electrical activity, with 312 (68%) surviving the initial episode and 156 (34%) surviving to hospital discharge. Survival to hospital discharge was worse in patients at the extremes of age with 76 (40%) patients aged > 75 y and 9 (45%) neonates surviving. Hospital survival was also associated with surgical priority, with 175 (88%) elective patients and 176 (37%) non-elective patients surviving to discharge. Outcomes varied with the cause of cardiac arrest, with lower initial survival rates for pulmonary embolism (5, 31%) and bone cement implantation syndrome (9, 45%), and hospital survival of < 25% for pulmonary embolism (0), septic shock (13, 24%) and significant hyperkalaemia (1, 20%). Overall care was rated good in 464 (53%) cases, and 18 (2%) cases had overall care rated as poor. Poor care elements were present in a further 245 (28%) cases. Care before cardiac arrest was the phase most frequently rated as poor (92, 11%) with elements of poor care identified in another 186 (21%) cases. These results describe the management and outcomes of peri-operative cardiac arrest in UK practice for the first time.
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Study on the Effects of Optimized Emergency Nursing Combined with Mild Hypothermia Nursing on Neurological Prognosis, Hemodynamics, and Cytokines in Patients with Cardiac Arrest. EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE 2022; 2022:1787312. [PMID: 35664942 PMCID: PMC9162833 DOI: 10.1155/2022/1787312] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/09/2022] [Accepted: 05/05/2022] [Indexed: 11/17/2022]
Abstract
Purpose To study the effects of optimized emergency nursing combined with mild hypothermia nursing on neurological prognosis, hemodynamics, and cytokines in patients with cardiac arrest (CA). Methods The medical records of 147 patients who were successfully rescued by cardiopulmonary resuscitation (CPR) after CA in our hospital were retrospectively analyzed. The 56 patients admitted in 2020 who received optimized emergency nursing were recorded as the control group; and the 91 patients admitted in 2021 who received optimized emergency nursing combined with mild hypothermia nursing were recorded as the study group. The brain function of the two groups at 72 h after return of spontaneous circulation (ROSC) was analyzed: cerebral performance category (CPC) assessment method. The neurological function of the two groups before nursing and 7, 30, and 90 d after nursing was analyzed: National Institutes of Health Stroke Scale (NISHH) score. The vital signs of the two groups after 24 h of nursing were analyzed: heart rate, spontaneous breathing rate, and blood oxygen saturation. The hemodynamic indexes of the two groups at 24 hours after nursing were analyzed: mean arterial pressure (MAP), central venous pressure (CVP), systolic blood pressure (SBP), and diastolic blood pressure (DBP). The levels of cytokines of the two groups before nursing and 7 days after nursing were analyzed: tumor necrosis factor-α (TNF-α), interleukin-6 (IL-6), and interleukin-8 (IL-8). The incidence of complications and the incidence of postresuscitation syndrome (PRS) during the nursing period were compared between the two groups. Results 72 h after ROSC, the CPC results in the study group were slightly better than those in the control group, but there was no significant difference in the number of cases of CPC Grade 1, CPC Grade 2, CPC Grade 3, CPC Grade 4, and CPC Grade 5 between the two groups (P > 0.05). Before nursing, there was no statistical difference in the NISHH total score between the two groups (P > 0.05). 7, 30, and 90 d after nursing, the NISHH total score between the two groups were lower than those before nursing, and the study group's score was lower than the control group's (P < 0.05). 24 h after nursing, the heart rate and spontaneous breathing rate of the study group were lower than those of the control group (P < 0.05), and there was no significant difference in blood oxygen saturation between the two groups (P > 0.05). 24 h after nursing, there was no significant difference in MAP, CVP, SBP, and DBP between the two groups (P > 0.05). Before nursing, there was no significant difference in the levels of TNF-α, IL-6, and IL-8 between the two groups (P > 0.05). 7 d after nursing, the levels of TNF-α, IL-6, and IL-8 between the two groups were lower than those before nursing, and the levels of the study group were lower than those of the control group (P < 0.05). During the nursing period, the total complication rates of the control group and the study group were 55.36% and 34.07%, respectively, with statistical difference (P < 0.05). During the nursing period, the incidences of PRS in the control group and the study group were 12.50% and 3.30%, respectively, with significant difference (P < 0.05). Conclusion The application of optimized emergency nursing combined with mild hypothermia nursing in CA can effectively improve the neurological prognosis and inflammatory levels of patients and reduce the incidence of body complications and PRS.
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7
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Kane AD, Armstrong RA, Kursumovic E, Cook TM, Soar J. The 7th UK National Audit Project (NAP7). The challenges of defining, studying and learning from peri-operative cardiac arrest. Anaesthesia 2021; 76:1026-1030. [PMID: 33982281 DOI: 10.1111/anae.15509] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/21/2021] [Indexed: 11/28/2022]
Affiliation(s)
- A D Kane
- Division of Surgery and Interventional Science, University College London, London, UK.,Department of Anaesthesia, James Cook University Hospital, Middlesbrough, UK
| | - R A Armstrong
- Department of Anaesthesia, Severn Deanery, Bristol, UK
| | - E Kursumovic
- Division of Surgery and Interventional Science, University College London, London, UK.,Department of Anaesthesia, Royal United Hospitals Bath NHS Foundation Trust, Bath, UK
| | - T M Cook
- Department of Anaesthesia and Intensive Care Medicine, Royal United Hospitals Bath NHS Foundation Trust, Bath, UK.,Anaesthesia, University of Bristol, Bristol, UK
| | - J Soar
- Department of Anaesthesia and Intensive Care Medicine, Southmead Hospital, Bristol, UK
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8
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Smith NK, Zerillo J, Kim SJ, Efune GE, Wang C, Pai SL, Chadha R, Kor TM, Wetzel DR, Hall MA, Burton KK, Fukazawa K, Hill B, Spad MA, Wax DB, Lin HM, Liu X, Odeh J, Torsher L, Kindscher JD, Mandell MS, Sakai T, DeMaria S. Intraoperative Cardiac Arrest During Adult Liver Transplantation: Incidence and Risk Factor Analysis From 7 Academic Centers in the United States. Anesth Analg 2021; 132:130-139. [PMID: 32167977 DOI: 10.1213/ane.0000000000004734] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND Intraoperative cardiac arrest (ICA) has a reported frequency of 1 in 10,000 anesthetics but has a much higher estimated incidence in orthotopic liver transplantation (OLT). Single-center studies of ICA in OLT are limited by small sample size that prohibits multivariable regression analysis of risks. METHODS Utilizing data from 7 academic medical centers, we performed a retrospective, observational study of 5296 adult liver transplant recipients (18-80 years old) between 2000 and 2017 to identify the rate of ICA, associated risk factors, and outcomes. RESULTS ICA occurred in 196 cases (3.7% 95% confidence interval [CI], 3.2-4.2) and mortality occurred in 62 patients (1.2%). The intraoperative mortality rate was 31.6% in patients who experienced ICA. In a multivariable generalized linear mixed model, ICA was associated with body mass index (BMI) <20 (odds ratio [OR]: 2.04, 95% CI, 1.05-3.98; P = .0386), BMI ≥40 (2.16 [1.12-4.19]; P = .022), Model for End-Stage Liver Disease (MELD) score: (MELD 30-39: 1.75 [1.09-2.79], P = .02; MELD ≥40: 2.73 [1.53-4.85], P = .001), postreperfusion syndrome (PRS) (3.83 [2.75-5.34], P < .001), living donors (2.13 [1.16-3.89], P = .014), and reoperation (1.87 [1.13-3.11], P = .015). Overall 30-day and 1-year mortality were 4.18% and 11.0%, respectively. After ICA, 30-day and 1-year mortality were 43.9% and 52%, respectively, compared to 2.6% and 9.3% without ICA. CONCLUSIONS We established a 3.7% incidence of ICA and a 1.2% incidence of intraoperative mortality in liver transplantation and confirmed previously identified risk factors for ICA including BMI, MELD score, PRS, and reoperation and identified new risk factors including living donor and length of surgery in this multicenter retrospective cohort. ICA, while rare, is associated with high intraoperative mortality, and future research must focus on therapy to reduce the incidence of ICA.
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Affiliation(s)
- Natalie K Smith
- From the Department of Anesthesiology, Perioperative and Pain Medicine, The Icahn School of Medicine at Mount Sinai, New York City, New York
| | - Jeron Zerillo
- From the Department of Anesthesiology, Perioperative and Pain Medicine, The Icahn School of Medicine at Mount Sinai, New York City, New York
| | - Sang Jo Kim
- Department of Anesthesiology, Hospital for Special Surgery, New York City, New York
| | - Guy E Efune
- Department of Anesthesiology and Pain Management, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Cynthia Wang
- Department of Anesthesiology, Greater Los Angeles VA Healthcare System, Los Angeles, California
| | - Sher-Lu Pai
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Jacksonville, Florida
| | - Ryan Chadha
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Jacksonville, Florida
| | - Todd M Kor
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, Minnesota
| | - David R Wetzel
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, Minnesota
| | - Michael A Hall
- Department of Anesthesiology, Christiana Care Health System, Newark, Delaware
| | - Kristen K Burton
- Department of Anesthesiology and Critical Care, Perelman School of Medicine University of Pennsylvania, Philadelphia, Pennsylvania
| | - Kyota Fukazawa
- Department of Anesthesiology and Pain Medicine, University of Washington School of Medicine, Seattle, Washington
| | - Bryan Hill
- Department of Anesthesiology, The Ohio State University, Columbus, Ohio
| | | | - David B Wax
- From the Department of Anesthesiology, Perioperative and Pain Medicine, The Icahn School of Medicine at Mount Sinai, New York City, New York
| | - Hung-Mo Lin
- Department of Population Health Science and Policy, The Icahn School of Medicine at Mount Sinai, New York City, New York
| | - Xiaoyu Liu
- Department of Anesthesiology, University of Kansas Medical Center, Kansas City, Kansas
| | - Jaffer Odeh
- Department of Anesthesiology and Pain Management, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Laurence Torsher
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, Minnesota
| | - James D Kindscher
- Department of Anesthesiology, University of Kansas Medical Center, Kansas City, Kansas
| | - M Susan Mandell
- Department of Anesthesiology, University of Colorado Hospital, Aurora, Colorado.,The Center for Perioperative & Pain Quality, Safety and Outcomes-PPQiSO, University of Washington Medical Center, Seattle, Washington
| | - Tetsuro Sakai
- Department of Anesthesiology and Perioperative Medicine, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Samuel DeMaria
- From the Department of Anesthesiology, Perioperative and Pain Medicine, The Icahn School of Medicine at Mount Sinai, New York City, New York
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Braghiroli KS, Einav S, Heesen MA, Villas Boas PJF, Braz JRC, Corrente JE, Porto DDSM, Morais AC, Neves GC, Braz MG, Braz LG. Perioperative mortality in older patients: a systematic review with a meta-regression analysis and meta-analysis of observational studies. J Clin Anesth 2020; 69:110160. [PMID: 33338975 DOI: 10.1016/j.jclinane.2020.110160] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2020] [Revised: 11/24/2020] [Accepted: 11/28/2020] [Indexed: 12/29/2022]
Abstract
STUDY OBJECTIVE Older patients have a higher probability of developing major complications during the perioperative period than other adult patients. Perioperative mortality depends on not only on a patient condition but also on the quality of perioperative care provided. We tested the hypothesis that the perioperative mortality rate among older patients has decreased over time and is related to a country's Human Development Index (HDI) status. DESIGN A systematic review with a meta-regression and meta-analysis of observational studies that reported perioperative mortality rates in patients aged ≥60 years was performed. We searched the PubMed, EMBASE, LILACS and SciELO databases from inception to December 30, 2019. SETTING Mortality rates up to the seventh postoperative day were evaluated. MEASUREMENTS We evaluated the quality of the included studies. Perioperative mortality rates were analysed by time, country HDI status and baseline American Society of Anesthesiologists (ASA) physical status using meta-regression. Perioperative mortality and ASA status were analysed in low- and high-HDI countries during two time periods using proportion meta-analysis. MAIN RESULTS We included 25 studies, which reported 4,412,100 anaesthesia procedures and 3568 perioperative deaths from 12 countries. Perioperative mortality rates in high-HDI countries decreased over time (P = 0.042). When comparing pre-1990 to 1990-2019, in high-HDI countries, the perioperative mortality rates per 10,000 anaesthesia procedures decreased 7.8-fold from 100.85 (95% CI 43.36 to 181.72) in pre-1990 to 12.98 (95% CI 6.47 to 21.70) in 1990-2019 (P < 0.0001). There were no studies from low-HDI countries pre-1990. In the period from 1990 to 2019, perioperative mortality rates did not differ between low- and high-HDI countries (P = 0.395) but the limited number of patients in low-HDI countries impaired the result. Perioperative mortality rates increased with increasing ASA status (P < 0.0001). There were more ASA III-V patients in high-HDI countries than in low-HDI countries (P < 0.0001), and the perioperative mortality rate increased 24-fold in ASA III-V patients compared with ASA I-II patients (P < 0.0001). CONCLUSION The perioperative mortality rates in older patients have declined over the past 60 years in high-DHI countries, highlighting that perioperative safety in this population is increasing in these countries. Since data prior to 1990 were lacking in low-HDI countries, the evolution of their mortality rates could not be analysed. The perioperative mortality rate was similar in low- and high-HDI countries in the post-1990 period, but the low number of patients in the low-HDI countries does not allow a definitive conclusion.
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Affiliation(s)
- Karen S Braghiroli
- Anaesthesia Cardiac Arrest and Mortality Study Commission, Department of Surgical Specialties and Anaesthesiology, Botucatu Medical School, Sao Paulo State University - UNESP, Brazil
| | - Sharon Einav
- Shaare Zedek Medical Centre, Jerusalem, Israel; Hebrew University of Jerusalem, Faculty of Medicine, Jerusalem, Israel
| | - Michael A Heesen
- Department of Anaesthesia, Kantonsspital Baden, Baden, Switzerland
| | - Paulo J F Villas Boas
- Department of Internal Medicine, Botucatu Medical School, Sao Paulo State University - UNESP, Brazil
| | - Jose R C Braz
- Anaesthesia Cardiac Arrest and Mortality Study Commission, Department of Surgical Specialties and Anaesthesiology, Botucatu Medical School, Sao Paulo State University - UNESP, Brazil
| | - Jose E Corrente
- Department of Biostatistics, Institute of Biosciences, Sao Paulo State University - UNESP, Brazil
| | - Daniela de S M Porto
- Anaesthesia Cardiac Arrest and Mortality Study Commission, Department of Surgical Specialties and Anaesthesiology, Botucatu Medical School, Sao Paulo State University - UNESP, Brazil
| | - Arthur C Morais
- Anaesthesia Cardiac Arrest and Mortality Study Commission, Department of Surgical Specialties and Anaesthesiology, Botucatu Medical School, Sao Paulo State University - UNESP, Brazil
| | - Gabriel C Neves
- Anaesthesia Cardiac Arrest and Mortality Study Commission, Department of Surgical Specialties and Anaesthesiology, Botucatu Medical School, Sao Paulo State University - UNESP, 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, Brazil
| | - Leandro G Braz
- Anaesthesia Cardiac Arrest and Mortality Study Commission, Department of Surgical Specialties and Anaesthesiology, Botucatu Medical School, Sao Paulo State University - UNESP, Brazil.
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Braz LG, Braz JRC, Modolo MP, Corrente JE, Sanchez R, Pacchioni M, Cury JB, Soares IB, Braz MG. Perioperative and anesthesia-related cardiac arrest and mortality rates in Brazil: A systematic review and proportion meta-analysis. PLoS One 2020; 15:e0241751. [PMID: 33137159 PMCID: PMC7605701 DOI: 10.1371/journal.pone.0241751] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2020] [Accepted: 10/20/2020] [Indexed: 01/02/2023] Open
Abstract
INTRODUCTION Studies have shown that both perioperative and anesthesia-related cardiac arrest (CA) and mortality rates are much higher in developing countries than in developed countries. This review aimed to compare the rates of perioperative and anesthesia-related CA and mortality during 2 time periods in Brazil. METHODS A systematic review with meta-analysis of full-text Brazilian observational studies was conducted by searching the Medline, EMBASE, LILACS and SciELO databases up to January 29, 2020. The primary outcomes were perioperative CA and mortality rates and the secondary outcomes included anesthesia-related CA and mortality events rates up to 48 postoperative hours. RESULTS Eleven studies including 719,273 anesthetic procedures, 962 perioperative CAs, 134 anesthesia-related CAs, 1,239 perioperative deaths and 29 anesthesia-related deaths were included. The event rates were evaluated in 2 time periods: pre-1990 and 1990-2020. Perioperative CA rates (per 10,000 anesthetics) decreased from 39.87 (95% confidence interval [CI]: 34.60-45.50) before 1990 to 17.61 (95% CI: 9.21-28.68) in 1990-2020 (P < 0.0001), while the perioperative mortality rate did not alter (from 19.25 [95% CI: 15.64-23.24] pre-1990 to 25.40 [95% CI: 13.01-41.86] in 1990-2020; P = 0.1984). Simultaneously, the anesthesia-related CA rate decreased from 14.39 (95% CI: 11.29-17.86) to 3.90 (95% CI: 2.93-5.01; P < 0.0001), while there was no significant difference in the anesthesia-related mortality rate (from 1.75 [95% CI: 0.76-3.11] to 0.67 [95% CI: 0.09-1.66; P = 0.5404). CONCLUSIONS This review demonstrates an important reduction in the perioperative CA rate over time in Brazil, with a large and consistent decrease in the anesthesia-related CA rate; however, there were no significant differences in perioperative and anesthesia-related mortality rates between the assessed time periods.
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Affiliation(s)
- Leandro G. Braz
- Department of Anesthesiology, Botucatu Medical School, Sao Paulo State University—UNESP, São Paulo, Brazil
| | - José R. C. Braz
- Department of Anesthesiology, Botucatu Medical School, Sao Paulo State University—UNESP, São Paulo, Brazil
| | - Marilia P. Modolo
- Department of Anesthesiology, Botucatu Medical School, Sao Paulo State University—UNESP, São Paulo, Brazil
| | - Jose E. Corrente
- Department of Biostatistics, Institute of Biosciences, Sao Paulo State University—UNESP, São Paulo, Brazil
| | - Rafael Sanchez
- Department of Anesthesiology, Botucatu Medical School, Sao Paulo State University—UNESP, São Paulo, Brazil
| | - Mariana Pacchioni
- Department of Anesthesiology, Botucatu Medical School, Sao Paulo State University—UNESP, São Paulo, Brazil
| | - Julia B. Cury
- Department of Anesthesiology, Botucatu Medical School, Sao Paulo State University—UNESP, São Paulo, Brazil
| | - Iva B. Soares
- Department of Anesthesiology, Botucatu Medical School, Sao Paulo State University—UNESP, São Paulo, Brazil
| | - Mariana G. Braz
- Department of Anesthesiology, Botucatu Medical School, Sao Paulo State University—UNESP, São Paulo, Brazil
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Epidemiology of perioperative cardiac arrest and mortality in Brazil: a systematic review. BRAZILIAN JOURNAL OF ANESTHESIOLOGY (ENGLISH EDITION) 2020. [PMID: 32475700 PMCID: PMC9373521 DOI: 10.1016/j.bjane.2020.04.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Background and objectives The perioperative cardiac arrest (CA) and mortality rates in Brazil, a developing country, are higher than in developed countries. The hypothesis of this review was that knowledge of the epidemiology of perioperative CA and mortality in Brazil enables the comparison with developed countries. The systematic review aimed to verify, in studies conducted in Brazil, the epidemiology of perioperative CA and mortality. Method and results A search strategy was carried out on different databases (PubMed, EMBASE, SciELO and LILACS) to identify observational studies that reported perioperative CA and/or mortality up to 48 hours postoperatively in Brazil. The primary outcomes were data on epidemiology of perioperative CA and mortality. In 8 Brazilian studies, there was a higher occurrence of perioperative CA and mortality in males; in extremes of age; in patients in worse physical status according to the American Society of Anesthesiologists (ASA); in emergency surgeries; in general anesthesia; and in cardiac, thoracic, vascular, abdominal and neurological surgeries. The patient's disease/condition was the main triggering factor, with sepsis and trauma as the main causes. Conclusions The epidemiology of both perioperative CA and mortality events reported in Brazilian studies does not show important differences and, in general, is similar to studies in developed countries. However, sepsis represents one of the major causes of perioperative CA and mortality in Brazilian studies, contrasting with studies in developed countries in which sepsis is a secondary cause.
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Braz LG, Morais ACD, Sanchez R, Porto DDSM, Pacchioni M, Serafim WDS, Módolo NSP, Jr PDN, Braz MG, Braz JRC. [Epidemiology of perioperative cardiac arrest and mortality in Brazil: a systematic review]. BRAZILIAN JOURNAL OF ANESTHESIOLOGY (ELSEVIER) 2020; 70:82-89. [PMID: 32475700 PMCID: PMC9373521 DOI: 10.1016/j.bjan.2020.02.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/12/2019] [Revised: 01/16/2020] [Accepted: 02/08/2020] [Indexed: 10/24/2022]
Abstract
BACKGROUND AND OBJECTIVES The perioperative cardiac arrest (CA) and mortality rates in Brazil, a developing country, are higher than in developed countries. The hypothesis of this review was that knowledge of the epidemiology of perioperative CA and mortality in Brazil enables the comparison with developed countries. The systematic review aimed to verify, in studies conducted in Brazil, the epidemiology of perioperative CA and mortality. METHOD AND RESULTS A search strategy was carried out on different databases (PubMed, EMBASE, SciELO and LILACS) to identify observational studies that reported perioperative CA and/or mortality up to 48 hours postoperatively in Brazil. The primary outcomes were data on epidemiology of perioperative CA and mortality. In 8 Brazilian studies, there was a higher occurrence of perioperative CA and mortality in males; in extremes of age; in patients in worse physical status according to the American Society of Anesthesiologists (ASA); in emergency surgeries; in general anesthesia; and in cardiac, thoracic, vascular, abdominal and neurological surgeries. The patient's disease/condition was the main triggering factor, with sepsis and trauma as the main causes. CONCLUSIONS The epidemiology of both perioperative CA and mortality events reported in Brazilian studies does not show important differences and, in general, is similar to studies in developed countries. However, sepsis represents one of the major causes of perioperative CA and mortality in Brazilian studies, contrasting with studies in developed countries in which sepsis is a secondary cause.
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Affiliation(s)
- Leandro Gobbo Braz
- Universidade Estadual Paulista (UNESP), Faculdade de Medicina de Botucatu, Departamento de Anestesiologia, Comissão de Estudo de Parada Cardíaca e de Mortalidade em Anestesia, Botucatu, SP, Brazil.
| | - Arthur Caus de Morais
- Universidade Estadual Paulista (UNESP), Faculdade de Medicina de Botucatu, Departamento de Anestesiologia, Comissão de Estudo de Parada Cardíaca e de Mortalidade em Anestesia, Botucatu, SP, Brazil
| | - Rafael Sanchez
- Universidade Estadual Paulista (UNESP), Faculdade de Medicina de Botucatu, Departamento de Anestesiologia, Comissão de Estudo de Parada Cardíaca e de Mortalidade em Anestesia, Botucatu, SP, Brazil
| | - Daniela de Sá Menezes Porto
- Universidade Estadual Paulista (UNESP), Faculdade de Medicina de Botucatu, Departamento de Anestesiologia, Comissão de Estudo de Parada Cardíaca e de Mortalidade em Anestesia, Botucatu, SP, Brazil
| | - Mariana Pacchioni
- Universidade Estadual Paulista (UNESP), Faculdade de Medicina de Botucatu, Departamento de Anestesiologia, Comissão de Estudo de Parada Cardíaca e de Mortalidade em Anestesia, Botucatu, SP, Brazil
| | - Williany Dark Silva Serafim
- Universidade Estadual Paulista (UNESP), Faculdade de Medicina de Botucatu, Departamento de Anestesiologia, Comissão de Estudo de Parada Cardíaca e de Mortalidade em Anestesia, Botucatu, SP, Brazil
| | - Norma Sueli Pinheiro Módolo
- Universidade Estadual Paulista (UNESP), Faculdade de Medicina de Botucatu, Departamento de Anestesiologia, Comissão de Estudo de Parada Cardíaca e de Mortalidade em Anestesia, Botucatu, SP, Brazil
| | - Paulo do Nascimento Jr
- Universidade Estadual Paulista (UNESP), Faculdade de Medicina de Botucatu, Departamento de Anestesiologia, Comissão de Estudo de Parada Cardíaca e de Mortalidade em Anestesia, Botucatu, SP, Brazil
| | - Mariana Gobbo Braz
- Universidade Estadual Paulista (UNESP), Faculdade de Medicina de Botucatu, Departamento de Anestesiologia, Comissão de Estudo de Parada Cardíaca e de Mortalidade em Anestesia, Botucatu, SP, Brazil
| | - José Reinaldo Cerqueira Braz
- Universidade Estadual Paulista (UNESP), Faculdade de Medicina de Botucatu, Departamento de Anestesiologia, Comissão de Estudo de Parada Cardíaca e de Mortalidade em Anestesia, Botucatu, SP, Brazil
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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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Pavão ALB, Mattos S, Silva E, Laguardia J, Doellinger V, Curi E, Casali T, Takaschima A, Almeida A, Albuquerque M, Nunes R. Eventos adversos em anestesiologia: análise por meio da ferramenta Logbook usada por médicos em especialização no Brasil. Braz J Anesthesiol 2019; 69:461-468. [DOI: 10.1016/j.bjan.2019.06.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2018] [Revised: 06/12/2019] [Accepted: 06/14/2019] [Indexed: 10/25/2022] Open
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Pavão ALB, Mattos S, Silva E, Laguardia J, Doellinger V, Curi E, Casali T, Takaschima A, Almeida A, Albuquerque M, Nunes R. Adverse events in anesthesiology: analysis based on the Logbook tool used by specializing physicians in Brazil. BRAZILIAN JOURNAL OF ANESTHESIOLOGY (ENGLISH EDITION) 2019. [PMID: 31564468 PMCID: PMC9391881 DOI: 10.1016/j.bjane.2019.06.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Logbook is a digital tool launched by the Brazilian Society of Anesthesiology in 2014 and has since been used. This tool allows physicians specializing in anesthesiology to record and store activities performed during the training period. This enabled a descriptive analysis of an extensive database of anesthetic procedures, as well as complications that occurred and were reported by these doctors. The present study includes the review of these data over a period of 2 years (2014–2015).
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Siriphuwanun V, Punjasawadwong Y, Saengyo S, Rerkasem K. Incidences and factors associated with perioperative cardiac arrest in trauma patients receiving anesthesia. Risk Manag Healthc Policy 2018; 11:177-187. [PMID: 30425598 PMCID: PMC6201994 DOI: 10.2147/rmhp.s178950] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Purpose The aim of this study was to determine the incidences and factors associated with perioperative cardiac arrest in trauma patients who received anesthesia for emergency surgery. Patients and methods This retrospective cohort study was approved by the medical ethical committee, Faculty of Medicine, Maharaj Nakorn Chiang Mai Hospital, Thailand. Data of 19,683 trauma patients who received anesthesia between January 2007 and December 2016, such as patient characteristics, surgery procedures, anesthesia information, anesthetic drugs, and cardiac arrest outcomes, were analyzed. Data of patients receiving local anesthesia by surgeons or monitoring anesthesia care (MAC) and those with much information missing were excluded. Factors associated with perioperative cardiac arrest were identified using univariate analysis and the multiple regression model. A stepwise algorithm was chosen at a P-value of <0.20 which was selected for multivariate analysis. A P-value of <0.05 was concluded as statistically significant. Results The perioperative cardiac arrest in trauma patients receiving anesthesia for emergency surgery was 170.04 per 10,000 cases. Factors associated with perioperative cardiac arrest in trauma patients were as follows: age >65 years (risk ratio [RR] =1.41, CI =1.02–1.96, P=0.039), American Society of Anesthesiologist (ASA) physical status 3 or higher (ASA physical status 3–4, RR =4.19, CI =2.09–8.38, P<0.001; ASA physical status 5–6, RR =21.58, CI =10.36–44.94, P<0.001), sites of surgery (intracranial, intrathoracic, upper intra-abdominal, and major vascular, each P<0.001), cardiopulmonary comorbidities (RR =1.55, CI =1.10–2.17, P=0.012), hemodynamic instability with shock prior to receiving anesthesia (RR =1.60, CI =1.21–2.11, P<0.001), and having a history of alcoholism (RR =5.27, CI =4.09–6.79, P<0.001). Conclusion The incidence of perioperative cardiac arrest in trauma patients receiving anesthesia for emergency surgery was very high and correlated with patient’s factors, especially old age and cardiopulmonary comorbidities, a history of drinking alcohol, increased ASA physical status, hemodynamic instability with shock prior to surgery, and sites of surgery such as brain, thorax, abdomen, and the major vascular region. Anesthesiologists and surgeons should be aware of a warning system and a well-equipped track to manage the surgical trauma patients.
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Affiliation(s)
- Visith Siriphuwanun
- Department of Anesthesiology, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Yodying Punjasawadwong
- Department of Anesthesiology, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Suwinai Saengyo
- Non-communicable Disease Center of Excellence and Department of Surgery, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand,
| | - Kittipan Rerkasem
- Non-communicable Disease Center of Excellence and Department of Surgery, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand, .,Non-communicable Disease Center of Excellence, Research Institute for Health Sciences, Chiang Mai University, Chiang Mai, Thailand,
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Parada cardíaca perioperatória: uma análise evolutiva da incidência de parada cardíaca intraoperatória em centros terciários no Brasil. Braz J Anesthesiol 2016; 66:176-82. [DOI: 10.1016/j.bjan.2016.01.001] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2014] [Accepted: 06/26/2014] [Indexed: 11/24/2022] Open
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Pignaton W, Braz JRC, Kusano PS, Módolo MP, de Carvalho LR, Braz MG, Braz LG. Perioperative and Anesthesia-Related Mortality: An 8-Year Observational Survey From a Tertiary Teaching Hospital. Medicine (Baltimore) 2016; 95:e2208. [PMID: 26765400 PMCID: PMC4718226 DOI: 10.1097/md.0000000000002208] [Citation(s) in RCA: 49] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
In 2006, a previous study at our institution reported high perioperative and anesthesia-related mortality rates of 21.97 and 1.12 per 10,000 anesthetics, respectively. Since then, changes in surgical practices may have decreased these rates. However, the actual perioperative and anesthesia-related mortality rates in Brazil remains unknown. The study aimed to reexamine perioperative and anesthesia-related mortality rates in one Brazilian tertiary teaching hospital.In this observational study, deaths occurring in the operation room and postanesthesia care unit between April 2005 and December 2012 were identified from an anesthesia database. The data included patient characteristics, surgical procedures, American Society of Anesthesiologists (ASA) physical status, and medical specialty teams, as well as the types of surgery and anesthesia. All deaths were reviewed and grouped by into 1 of 4 triggering factors groups: totally anesthesia-related, partially anesthesia-related, surgery-related, or disease/condition-related. The mortality rates are expressed per 10,000 anesthetics with 95% confidence intervals (CIs).A total of 55,002 anesthetics and 88 deaths were reviewed, representing an overall mortality rate of 16.0 per 10,000 anesthetics (95% CI: 13.0-19.7). There were no anesthesia-related deaths. The major causes of mortality were patient disease/condition-related (13.8, 95% CI: 10.7-16.9) followed by surgery-related (2.2, 95% CI: 1.0-3.4). The major risks of perioperative mortality were children younger than 1-year-old, older patients, patients with poor ASA physical status (III-V), emergency, cardiac or vascular surgeries, and multiple surgeries performed under the same anesthetic technique (P < 0.0001).There were no anesthesia-related deaths. However, the high mortality rate caused by the poor physical conditions of some patients suggests that primary prevention might be the key to reducing perioperative mortality. These findings demonstrate the need to improve medical perioperative practices for high-risk patients in under-resourced settings.
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Affiliation(s)
- Wangles Pignaton
- From the Anesthesia Cardiac Arrest and Mortality Study Commission, Department of Anesthesiology, Botucatu Medical School (WP, JRCB, PSK, MPM, MGB, LGB); and Department of Biostatistics, Institute of Biosciences, UNESP, University Estadual Paulista, Botucatu, Brazil (LRDC)
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Perioperative cardiac arrest: an evolutionary analysis of the intra-operative cardiac arrest incidence in tertiary centers in Brazil. Braz J Anesthesiol 2015; 66:176-82. [PMID: 26952227 DOI: 10.1016/j.bjane.2014.06.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2014] [Accepted: 06/26/2014] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND Great changes in medicine have taken place over the last 25 years worldwide. These changes in technologies, patient risks, patient profile, and laws regulating the medicine have impacted the incidence of cardiac arrest. It has been postulated that the incidence of intraoperative cardiac arrest has decreased over the years, especially in developed countries. The authors hypothesized that, as in the rest of the world, the incidence of intraoperative cardiac arrest is decreasing in Brazil, a developing country. OBJECTIVES The aim of this study was to search the literature to evaluate the publications that relate the incidence of intraoperative cardiac arrest in Brazil and analyze the trend in the incidence of intraoperative cardiac arrest. CONTENTS There were 4 articles that met our inclusion criteria, resulting in 204,072 patients undergoing regional or general anesthesia in two tertiary and academic hospitals, totalizing 627 cases of intraoperative cardiac arrest. The mean intraoperative cardiac arrest incidence for the 25 years period was 30.72:10,000 anesthesias. There was a decrease from 39:10,000 anesthesias to 13:10,000 anesthesias in the analyzed period, with the related lethality from 48.3% to 30.8%. Also, the main causes of anesthesia-related cause of mortality changed from machine malfunction and drug overdose to hypovolemia and respiratory causes. CONCLUSIONS There was a clear reduction in the incidence of intraoperative cardiac arrest in the last 25 years in Brazil. This reduction is seen worldwide and might be a result of multiple factors, including new laws regulating the medicine in Brazil, incorporation of technologies, better human development level of the country, and better patient care.
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