Predictors of functional outcome after intraoperative cardiac arrest

黄建宏

Predictors of functional outcome after intraoperative cardiac arrest

Anesthesiologists have little knowledge about functional outcomes in patients who survive intraoperative cardiac arrest. Constant et al (1) recently published their study in Anesthesiology. They reviewed the medical records to identify factors associated with 90-day favorable functional outcomes in adults admitted to the ICU after successful resuscitation of intraoperative cardiac arrest,

For 13-year period, they had 869,425 patients receiving anesthesia for a surgical procedure. The authors identified 140 patients who were successfully resuscitated intraoperative cardiac arrest.

Timing of occurrence of cardiac arrest: 52% during surgery, 16% just after induction, 13% during induction, 8% before induction, 2% just after extubation.

The initial recorded rhythms were asystole (52%), pulseless electrical activity (31%), ventricular fibrillation (16%).

Etiology of cardiac arrest: preoperative complications 33%, anesthesia 28%, surgical procedure 26%, patient characteristics 14%, hemorrhagic shock 24%, anaphylactic shock 15%.

Outcomes:

Cerebral performance category score (CPC I) on day-90: CPC 1(good cerebral performance): 37%;

CPC II (moderate cerebral disability) 8%; CPC III (severe cerebral disability) 5%, CPC IV (vegetative state) 1%, CPC V (death): 49%

Conclusions: after 90 days, 45% of patients had achieved a good recovery.

Reference: (1)Constant A, Montlahuc C, et al: Predictors of functional outcome after intraoperative cardiac arrest. Anesthesiology 2014; 121:482-91