An audit of perioperative cardiac arrests in a Southeast Asian university teaching hospital over 15 years.
An audit of the incidence, causes and outcome of perioperative cardiac arrest was conducted in a university hospital in Pakistan. All perioperative cardiac arrests from induction of anaesthesia to post anaesthesia care unit discharge or intensive care unit admission during noncardiac surgery, from January 1992 to December 2006 were included. Patients' demographic information, physical status and type of surgery and anaesthesia were noted. Outcome variables were noted as immediate survival and survival to discharge. Anaesthesia-related cardiac arrests were identified and their causes analysed. Forty-two cardiac arrests occurred among 140,384 patients. Overall frequency was 2.99 per 10,000 (95% confidence interval: 2.90 to 3.08). Twenty-four (3.77/10,000) were females. Thirty-four (13.59/10,000) patients were ASA physical status III to V, 10 (4.95/10,000) were children and 14 (4.28/10,000) above 60 years. Sixteen patients (6.48/10,000) were undergoing emergency surgery. Anaesthesia was deemed primarily responsible in nine cases (0.64/10,000). The causes of anaesthesia-related arrests were medication related (4), airway related (3), massive air embolism (1) and under-replacement of fluids (1). The event was considered to be avoidable in 26 cases. Seventeen patients died during the arrest, 15 survived more than one hour and 10 were discharged home. The number of perioperative cardiac arrests and their mortality was higher in patients with poor physical status and in emergency surgery. The number was also higher in infants, patients above 60 and females. The majority of the cases were considered avoidable, indicating the importance of prevention strategies.
Department ofAnaesthesia, Aga Khan University Hospital, Karachi, Pakistan.
A
A
Ahmed
M
M
Ali
E A
EA
Khan
M U
MU
Khan
D000293:Adolescent; D000328:Adult; D017677:Age Distribution; D000758:Anesthesia / Q000009:adverse effects*; D001210:Asia, Southeastern / Q000453:epidemiology; D015984:Causality; D002648:Child; D002675:Child, Preschool; D004632:Emergency Medical Services / Q000706:statistics & numerical data; D005260:Female; D006304:Health Status; D006323:Heart Arrest / Q000139:chemically induced / Q000453:epidemiology*; D006784:Hospitals, Teaching / Q000706:statistics & numerical data*; D006785:Hospitals, University / Q000706:statistics & numerical data*; D006801:Humans; D015994:Incidence; D007223:Infant; D008297:Male; D008485:Medical Audit / Q000706:statistics & numerical data*; D008875:Middle Aged; D019990:Perioperative Care / Q000706:statistics & numerical data*; D012307:Risk Factors; D017678:Sex Distribution; D016019:Survival Analysis; D055815:Young Adult