Predictors of Survival from Perioperative Cardiopulmonary Arrests: A Retrospective Analysis of 2,524 Events from the Get With The Guidelines-Resuscitation Registry

Satya Krishna Ramachandran MD FRCA Director, Quality Assurance Department of Anesthesiology University of MichiganMedicalResearch.com eInterview with
Satya Krishna Ramachandran MD FRCA
Director, Quality Assurance
Department of Anesthesiology
University of Michigan

MedicalResearch.com: What are the main findings of the study?

Answer:

  • Background: A cardiac arrest is a life-threatening condition where the heart has stopped beating. This remains one of the biggest fears of patients undergoing anesthesia and surgery. This is a rare complication around anesthesia, with only seven arrests per 10,000 patients undergoing surgeries unrelated to the heart. Although this is a rare complication nowadays, previous research has provided limited understanding of risk factors and outcomes.  Cardiac arrests that happen during or soon after anesthesia and surgery may present themselves in different ways and have differences in survival or further complications. By studying these arrests in a large national database of cardiac arrests called the “Get With The Guidelines – Resuscitation” registry, we were able to identify over 2,500 instances of cardiac arrest occurring during or soon after anesthesia. This database is supported by the American Heart Association and has specific information on patient conditions, life-saving treatments and recovery from the arrests.
  • Findings: Cardiac arrests that happen during or immediately after anesthesia are rare events. But we have found that recovery from these events is much better than previous reports of arrests from other hospital locations. We have also found that life-saving treatment is given extremely rapidly in the operating room and the post-anesthesia care unit. These are two locations that anesthesiologists and peri-anesthesia nurses closely monitor patients for complications. We believe that the better recovery seen in these places is because of the immediate availability of these trained caregivers.

MedicalResearch.com: Were any of the findings unexpected?

Answer:

  • Specifically, recovery from asystole (a type of cardiac arrest where the electrical activity of the heart completely stops) in the operating room is at least three times better than previous reports from other hospital locations. We also found that life-saving treatment was given much faster in these locations. We think this improved survival is mainly because of the presence of trained anesthesiologists and nurse providers who directly monitor and respond quickly to any cardiac arrest situation.
  • Patients developing arrests during or immediately after anesthesia (in the post-anesthesia care unit) were more likely to survive with good brain function than other hospital locations.  We believe that the presence of trained anesthesiologists in both locations improve chances of good recovery due to careful monitoring and immediate responses to these uncommon events.

MedicalResearch.com: What should clinicians and patients take away from your report?

Answer:

  • We found that one out of every three patients who develop a perioperative cardiac arrest survives to hospital discharge. We also found that two out of every three patients who survived had no signs of brain damage after the arrest.
  • We also identified several risk-conditions during hospital admission that reduce the chance of successful recovery from a perioperative cardiac arrest. These include major trauma, heart failure, low blood pressure, electrolyte disturbances, kidney failure, late stage cancer, major infection of the blood, and breathing difficulties. Patients with older age and longer arrest times had reduced chance of successful recovery.
  • The following conditions improved chances of successful recovery from arrests: presence of a heart rhythm abnormality, ventricular fibrillation arrest, and difficulty in keeping open the breathing passage. We showed that patients recover better from cardiac arrests that happen during or immediately after anesthesia, compared to other hospital locations. However, we also found that arrests that happen during weekends and at night have worse outcomes.

MedicalResearch.com: What recommendations do you have for future research as a result of this study?

Answer:

  • Research into the role of monitoring in preventing postoperative complications including cardiac arrests is essential. There are concerns about inadequate monitoring of postoperative patients in US hospitals. On the other hand, there are concerns that increasing the level of monitoring also increases nursing fatigue to alarms, similar to a “cry-wolf” situation. As most monitoring strategies are potentially associated with immense healthcare benefits, costs and risks, good quality research into the value and effectiveness of monitoring postoperative patients is essential.
  • We also found that patients who had signs of brain damage at the time of hospital admission had the lowest chance of surviving the arrest and recovering their brain function. In these patients, the chance of good recovery was low, even if they did not have any other major risk-conditions listed above. On the other hand, patients who had good brain function at the time of hospital admission had a good chance of recovery even if they had many risk-conditions listed above.  Future research into do-not-resuscitate orders needs to incorporate this finding.

Citation:

Predictors of Survival from Perioperative Cardiopulmonary Arrests: A Retrospective Analysis of 2,524 Events from the Get With The Guidelines-Resuscitation Registry

Ramachandran, Satya Krishna; Mhyre, Jill; Kheterpal, Sachin; Christensen, Robert E.; Tallman, Kristen; Morris, Michelle; Chan, Paul S.; for the American Heart Association’s Get With The Guidelines-Resuscitation Investigators

Anesthesiology., POST AUTHOR CORRECTIONS, 30 April 2013
doi: 10.1097/ALN.0b013e318289bafe

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