Anesthesia-related cardiac arrest.
BACKGROUND
Much is still unknown about the actual incidence of anesthesia-related cardiac arrest in the United States.


METHODS
The authors identified all of the cases of cardiac arrest from their quality improvement database from 1999 to 2009 and submitted them for review by an independent study commission to give them the best estimate of anesthesia-related cardiac arrest at their institution. One hundred sixty perioperative cardiac arrests within 24 h of surgery were identified from an anesthesia database of 217,365 anesthetics. An independent study commission reviewed all case abstracts to determine which cardiac arrests were anesthesia-attributable or anesthesia-contributory. Anesthesia-attributable cardiac arrests were those cases in which anesthesia was determined to be the primary cause of cardiac arrest. Anesthesia-contributory cardiac arrests were those cases where anesthesia was determined to have contributed to the cardiac arrest.


RESULTS
Fourteen cardiac arrests were anesthesia-attributable, resulting in an incidence of 0.6 per 10,000 anesthetics (95% CI, 0.4 to 1.1). Twenty-three cardiac arrests were found to be anesthesia-contributory resulting in an incidence of 1.1 per 10,000 anesthetics (95% CI, 0.7 to 1.6). Sixty-four percent of anesthesia-attributable cardiac arrests were caused by airway complications that occurred primarily with induction, emergence, or in the postanesthesia care unit, and mortality was 29%. Anesthesia-contributory cardiac arrest occurred during all phases of the anesthesia, and mortality was 70%.


CONCLUSIONS
As judged by an independent study commission, anesthesia-related cardiac arrest occurred in 37 of 160 cardiac arrests within the 24-h perioperative period.
From the Department of Anesthesiology, University of Nebraska Medical Center, Omaha, Nebraska (S.J.E., M.C.N., J.A.S., K.R.P., J.H.T., S.J.L.); Veterans Affairs Nebraska Western-Iowa Healthcare System, and Department of Internal Medicine, University of Nebraska Medical Center, Omaha, Nebraska (D.J.R.); Department of Surgery, University of Nebraska Medical Center, Omaha, Nebraska (D.W.M.); Department of Anesthesiology, The Ohio State University Wexner Medical Center, Columbus, Ohio (R.L.H.); Department of Anesthesiology, University of Kansas Medical Center, Kansas City, Kansas (J.D.K.); and Department of Biostatistics, College of Public Health, University of Nebraska Medical Center, Omaha, Nebraska (F.Q.).
Sheila J
SJ
Ellis
Myrna C
MC
Newland
Jean A
JA
Simonson
K Reed
KR
Peters
Debra J
DJ
Romberger
David W
DW
Mercer
John H
JH
Tinker
Ronald L
RL
Harter
James D
JD
Kindscher
Fang
F
Qiu
Steven J
SJ
Lisco
D000293:Adolescent; D000328:Adult; D017677:Age Distribution; D000368:Aged; D000369:Aged, 80 and over; D000758:Anesthesia / Q000009:adverse effects* / Q000706:statistics & numerical data*; D015984:Causality; D002648:Child; D002675:Child, Preschool; D016208:Databases, Factual / Q000706:statistics & numerical data; D005260:Female; D006323:Heart Arrest / Q000453:epidemiology* / Q000209:etiology; D017052:Hospital Mortality; D006801:Humans; D015994:Incidence; D007223:Infant; D008297:Male; D008875:Middle Aged; D017678:Sex Distribution; D011795:Surveys and Questionnaires; D014481:United States / Q000453:epidemiology; D055815:Young Adult