title: Perioperative cardiac arrest: an evolutionary analysis of the intra-operative cardiac arrest incidence in tertiary centers in Brazil.
abstract: BACKGROUND
  Great changes in medicine have taken place over the last 25 years worldwide. These changes in technologies, patient risks, patient profile, and laws regulating the medicine have impacted the incidence of cardiac arrest. It has been postulated that the incidence of intraoperative cardiac arrest has decreased over the years, especially in developed countries. The authors hypothesized that, as in the rest of the world, the incidence of intraoperative cardiac arrest is decreasing in Brazil, a developing country.
  
  
  OBJECTIVE
  The aim of this study was to search the literature to evaluate the publications that relate the incidence of intraoperative cardiac arrest in Brazil and analyze the trend in the incidence of intraoperative cardiac arrest.
  
  
  BACKGROUND
  There were 4 articles that met our inclusion criteria, resulting in 204,072 patients undergoing regional or general anesthesia in two tertiary and academic hospitals, totalizing 627 cases of intraoperative cardiac arrest. The mean intraoperative cardiac arrest incidence for the 25 years period was 30.72:10,000 anesthesias. There was a decrease from 39:10,000 anesthesias to 13:10,000 anesthesias in the analyzed period, with the related lethality from 48.3% to 30.8%. Also, the main causes of anesthesia-related cause of mortality changed from machine malfunction and drug overdose to hypovolemia and respiratory causes.
  
  
  CONCLUSIONS
  There was a clear reduction in the incidence of intraoperative cardiac arrest in the last 25 years in Brazil. This reduction is seen worldwide and might be a result of multiple factors, including new laws regulating the medicine in Brazil, incorporation of technologies, better human development level of the country, and better patient care.
authors.affiliation: Discipline of Anesthesiology, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, SP, Brazil. Electronic address: mfvane@uol.com.br.
authors.forename: Matheus Fachini
authors.initials: MF
authors.lastname: Vane
authors.affiliation: Discipline of Anesthesiology, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, SP, Brazil.
authors.forename: Rafael Ximenes
authors.initials: RX
authors.lastname: do Prado Nuzzi
authors.affiliation: Discipline of Anesthesiology, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, SP, Brazil.
authors.forename: Gustavo Fabio
authors.initials: GF
authors.lastname: Aranha
authors.affiliation: Discipline of Anesthesiology, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, SP, Brazil.
authors.forename: Vinicius Fernando
authors.initials: VF
authors.lastname: da Luz
authors.affiliation: Discipline of Anesthesiology, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, SP, Brazil.
authors.forename: Luiz Marcelo
authors.initials: LM
authors.lastname: Sá Malbouisson
authors.affiliation: Heart Institue (InCor), Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, SP, Brazil.
authors.forename: Maria Margarita Castro
authors.initials: MM
authors.lastname: Gonzalez
authors.affiliation: Discipline of Anesthesiology, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, SP, Brazil.
authors.forename: José Otávio Costa
authors.initials: JO
authors.lastname: Auler
authors.affiliation: Discipline of Anesthesiology, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, SP, Brazil.
authors.forename: Maria José Carvalho
authors.initials: MJ
authors.lastname: Carmona
mesh_terms: D000758:Anesthesia / Q000009:adverse effects* / Q000379:methods; D001938:Brazil / Q000453:epidemiology; D006323:Heart Arrest / Q000453:epidemiology*; D006801:Humans; D015994:Incidence; D007431:Intraoperative Complications / Q000453:epidemiology*; D062606:Tertiary Care Centers
keywords: Anestesia; Anesthesia; Cardiopulmonary resuscitation; Complicações intraoperatórias; Heart arrest; Intra-operative complications; Parada cardíaca; Reanimação cardiopulmonar