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Incidence, Outcomes, and Risk Factors for Preincision Cardiac Arrest in Cardiac Surgery Patients.
Geube, Mariya A; Hsu, Albert; Skubas, Nikolaos J; Liang, Chen; Mi, Junhui; Knuf, Kayla M; Marciniak, Donn; Tong, Michael Zhen-Yu; Duncan, Andra E.
Afiliação
  • Geube MA; From the Departments of Cardiothoracic Anesthesiology.
  • Hsu A; From the Departments of Cardiothoracic Anesthesiology.
  • Skubas NJ; From the Departments of Cardiothoracic Anesthesiology.
  • Liang C; Quantitative Health Services.
  • Mi J; Quantitative Health Services.
  • Knuf KM; From the Departments of Cardiothoracic Anesthesiology.
  • Marciniak D; From the Departments of Cardiothoracic Anesthesiology.
  • Tong MZ; Cardiothoracic Surgery, Cleveland Clinic, Cleveland, Ohio.
  • Duncan AE; From the Departments of Cardiothoracic Anesthesiology.
Anesth Analg ; 135(6): 1189-1197, 2022 12 01.
Article em En | MEDLINE | ID: mdl-36155546
ABSTRACT

BACKGROUND:

We examined the incidence, postoperative outcomes, and patient-related factors associated with preincision cardiac arrest in patients undergoing cardiac surgery.

METHODS:

We retrospectively examined adult patients undergoing elective or urgent cardiac surgery at the Cleveland Clinic between 2008 and 2019. The incidence of preincision cardiac arrest, defined as arrest between induction of general anesthesia and surgical incision, was reported. In a secondary analysis, we assessed the association between preincision cardiac arrest and major postoperative outcomes. In a tertiary analysis, we used adjusted linear regression models to explore the association between preincision cardiac arrest and prespecified patient risk factors, including severe left main coronary artery stenosis, left ventricular ejection fraction, moderate/severe right ventricular dysfunction, low-flow low-gradient aortic stenosis, and moderate/severe pulmonary hypertension.

RESULTS:

Preincision cardiac arrests occurred in 75 of 41,238 (incidence of 0.18%; 95% CI, 0.17-0.26) patients who had elective or urgent cardiac surgery. Successful cardiopulmonary resuscitation with return of spontaneous circulation or bridge to cardiopulmonary bypass occurred in 74 of 75 (98.6%) patients. Patients who experienced preincision cardiac arrest had significantly higher in-hospital mortality than those who did not (11% vs 2%; odds ratio [OR] (95% CI), 4.14 (1.94-8.84); P < .001). They were also more likely to suffer postoperative respiratory failure (46% vs 13%; OR [95% CI], 3.94 [2.40-6.47]; P < .001), requirement for renal replacement therapy (11% vs 2%; OR [95% CI], 3.90 [1.82-8.35]; P < .001), neurologic deficit (7% vs 2%; OR [95% CI], 2.49 (1.00-6.21); P = .05), and longer median hospital stay (15 vs 8 days; hazard ratio (HR) [95% CI], 0.68 [0.55-0.85]; P < .001). Reduced left ventricular ejection fraction (per 5% decrease) (OR [95% CI], 1.13 [1.03-1.22]; P = .006) and moderate/severe pulmonary hypertension (OR [95% CI], 3.40 [1.95-5.90]; P < .001) were identified as independent risk factors for cardiac arrest.

CONCLUSIONS:

Cardiac arrest after anesthetic induction is rare in cardiac surgical patients in our investigation. Though most patients are rescued, morbidity and mortality remain higher. Reduced left ventricular ejection fraction and moderate/severe pulmonary hypertension are associated with greater risk for preincision cardiac arrest.
Assuntos

Texto completo: 1 Coleções: 01-internacional Contexto em Saúde: 6_ODS3_enfermedades_notrasmisibles Base de dados: MEDLINE Assunto principal: Parada Cardíaca / Procedimentos Cirúrgicos Cardíacos / Hipertensão Pulmonar Tipo de estudo: Diagnostic_studies / Etiology_studies / Incidence_studies / Observational_studies / Prognostic_studies / Risk_factors_studies Limite: Adult / Humans Idioma: En Revista: Anesth Analg Ano de publicação: 2022 Tipo de documento: Article

Texto completo: 1 Coleções: 01-internacional Contexto em Saúde: 6_ODS3_enfermedades_notrasmisibles Base de dados: MEDLINE Assunto principal: Parada Cardíaca / Procedimentos Cirúrgicos Cardíacos / Hipertensão Pulmonar Tipo de estudo: Diagnostic_studies / Etiology_studies / Incidence_studies / Observational_studies / Prognostic_studies / Risk_factors_studies Limite: Adult / Humans Idioma: En Revista: Anesth Analg Ano de publicação: 2022 Tipo de documento: Article