The incidence and risk factors for perioperative cardiac arrest observed in the national anesthesia clinical outcomes registry.
BACKGROUND
Cardiac arrest is a rare but important event in the operating room and postanesthesia care unit, when surgical patients are most intensively monitored. Several recent publications have reported the rate of cardiac arrest in surgical patients during the subsequent hospital stay but have not uniquely identified the immediate perioperative period. We hypothesized that cardiac arrest during this time (intraprocedure and postanesthesia care) would occur at a lower frequency than that described for inpatient hospital care in the available literature.


METHODS
We extracted data from all cardiac arrests and immediate perioperative deaths reported to the National Anesthesia Clinical Outcomes Registry for the period from 2010 to 2013 and analyzed for anesthesia-related risk factors. We compared these data to published rates of in-hospital cardiac arrest after surgery.


RESULTS
Overall, the risk of cardiac arrest was 5.6 per 10,000 cases, which is less than in previous reports of in-hospital arrests in surgical patients overall, with an associated mortality from the arrest of 58.4%. The rate of cardiac arrest increased with age and ASA physical status. The rate of cardiac arrest was significantly higher for males, as was the mortality.


CONCLUSIONS
The National Anesthesia Clinical Outcomes Registry is an emerging resource for examination of perioperative and anesthesia-related outcomes. Cardiac arrest is less frequent in the periprocedural setting than later in the hospital course, with most arrests predictably occurring in patients with ASA physical status III-V. The finding of increased risk of mortality in male patients cannot be readily explained and should prompt future research attention.
From the *Department of Anesthesia and Critical Care, The University of Chicago, Chicago, Illinois; and †Anesthesia Quality Institute, Park Ridge, Illinois.
Mark E
ME
Nunnally
Michael F
MF
O'Connor
Hubert
H
Kordylewski
Benjamin
B
Westlake
Richard P
RP
Dutton
D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D000758:Anesthesia / Q000009:adverse effects*; D002648:Child; D002675:Child, Preschool; D016208:Databases, Factual; D005260:Female; D006323:Heart Arrest / Q000453:epidemiology* / Q000401:mortality; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D007431:Intraoperative Complications / Q000453:epidemiology* / Q000401:mortality; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000453:epidemiology* / Q000401:mortality; D012042:Registries; D012189:Retrospective Studies; D012307:Risk Factors; D016019:Survival Analysis; D016896:Treatment Outcome; D014481:United States / Q000453:epidemiology; D055815:Young Adult