title: Predictors of survival from perioperative cardiopulmonary arrests: a retrospective analysis of 2,524 events from the Get With The Guidelines-Resuscitation registry.
abstract: BACKGROUND
  Perioperative cardiopulmonary arrests are uncommon and little is known about rates and predictors of in-hospital survival.
  
  
  METHODS
  Using the Get With The Guidelines®-Resuscitation national in-hospital resuscitation registry, we identified all patients aged 18 yr or older who experienced an index, pulseless cardiac arrest in the operating room or within 24 h postoperatively. The primary outcome was survival to hospital discharge, and the secondary outcome was neurologically intact recovery among survivors. Multivariable logistic regression models using generalized estimating equation models were used to identify independent predictors of survival and neurologically intact survival.
  
  
  RESULTS
  A total of 2,524 perioperative cardiopulmonary arrests were identified from 234 hospitals. The overall rate of survival to discharge was 31.7% (799/2,524), including 41.8% (254/608) for ventricular tachycardia and ventricular fibrillation, 30.5% (296/972) for asystole, and 26.4% (249/944) for pulseless electrical activity. Ventricular fibrillation and pulseless ventricular tachycardia were independently associated with improved survival. Asystolic arrests occurring in the operating room and postanesthesia care unit were associated with improved survival when compared to other perioperative locations. Among patients with neurological status assessment at discharge, the rate of neurologically intact survival was 64.0% (473/739). Prearrest neurological status at admission, patient age, inadequate natural airway, prearrest ventilatory support, duration of event, and event location were significant predictors of neurological status at discharge.
  
  
  CONCLUSIONS
  Among patients with a perioperative cardiac arrest, one in three survived to hospital discharge, and good neurological outcome was noted in two of three survivors.
authors.affiliation: *Assistant Professor, ‡Research Coordinator, Department of Anesthesiology, University of Michigan, Ann Arbor, Michigan.†Perianesthesia Nurse, Department of Nursing, University of Michigan.§Assistant Professor, Saint Luke's Mid America Heart Institute, Kansas City, Missouri. ‖ The American Heart Association's Get With The Guidelines-Resuscitation Investigators are listed in appendix 1.
authors.forename: Satya Krishna
authors.initials: SK
authors.lastname: Ramachandran
authors.forename: Jill
authors.initials: J
authors.lastname: Mhyre
authors.forename: Sachin
authors.initials: S
authors.lastname: Kheterpal
authors.forename: Robert E
authors.initials: RE
authors.lastname: Christensen
authors.forename: Kristen
authors.initials: K
authors.lastname: Tallman
authors.forename: Michelle
authors.initials: M
authors.lastname: Morris
authors.forename: Paul S
authors.initials: PS
authors.lastname: Chan
mesh_terms: D000368:Aged; D058109:Airway Management; D015897:Comorbidity; D004562:Electrocardiography; D005260:Female; D005544:Forecasting; D017408:Guidelines as Topic; D006323:Heart Arrest / Q000401:mortality*; D017052:Hospital Mortality; D006801:Humans; D008297:Male; D008875:Middle Aged; D009422:Nervous System Diseases / Q000453:epidemiology / Q000503:physiopathology; D016017:Odds Ratio; D009873:Operating Rooms; D010361:Patients; D059035:Perioperative Period; D011183:Postoperative Complications / Q000503:physiopathology / Q000523:psychology; D011997:Recovery Room; D012042:Registries; D012189:Retrospective Studies; D012307:Risk Factors; D016019:Survival Analysis; D017741:Survivors; D016896:Treatment Outcome