Improved survival after intraoperative cardiac arrest in noncardiac surgical patients.
OBJECTIVE
To test the hypothesis that improvements in intraoperative and perioperative critical care are resulting in an improved outcome after intraoperative cardiac arrest.


METHODS
A retrospective consecutive series of patients who experienced an intraoperative cardiac arrest during noncardiothoracic surgical procedures between January 1986 and June 1994.


METHODS
A tertiary care university-based hospital.


METHODS
Twenty-four consecutive patients who experienced an intraoperative arrest among 162,661 noncardiothoracic surgical procedures during the designated period.


METHODS
Advanced cardiac life support and advanced trauma life support methods were used appropriately. Postarrest pharmacologic and mechanical cardiopulmonary support were used as needed in the setting of a surgical intensive care unit.


METHODS
Survival out of the operating room and survival to discharge.


RESULTS
Fifteen patients (62%) were resuscitated in the operating room and taken to the surgical intensive care unit or recovery room. Nine patients (38%) survived to discharge from the hospital. Twelve arrests (50%) were primarily cardiac in origin. Predictors of mortality included a need for pressor or inotropic support (P < .001) and duration of the arrest greater than 15 minutes (P < .001).


CONCLUSIONS
Survival from an intraoperative cardiac arrest in a noncardiothoracic surgical patient is much improved over rates in historical controls who experienced in-hospital and out-of-hospital cardiac arrest. Rapid identification and aggressive correction of mechanical and metabolic derangements is warranted.
Girardi
L N
LN
Department of Surgery, New York Hospital, Cornell Medical Center, NY.
Barie
P S
PS
D000293:Adolescent; D000328:Adult; D000368:Aged; D002648:Child; D002675:Child, Preschool; D003422:Critical Care; D005260:Female; D006323:Heart Arrest / Q000209:etiology / Q000401:mortality / Q000628:therapy*; D017052:Hospital Mortality; D006785:Hospitals, University / Q000706:statistics & numerical data; D006801:Humans; D007362:Intensive Care Units / Q000706:statistics & numerical data*; D007431:Intraoperative Complications / Q000401:mortality / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D009519:New York City / Q000453:epidemiology; D012189:Retrospective Studies; D016896:Treatment Outcome