Perioperative cardiac arrest in 457,529 anesthetized patients at a single teaching hospital in Korea: a retrospective study

Choi, Yoon Ji; Han, Seon Uk; Woo, Seunghoon; Ro, Young Jin; Yang, Hong Seuk

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Anesthesia and Pain Medicine 2014;9(2):144-151.
Published online April 30, 2014.

Perioperative cardiac arrest in 457,529 anesthetized patients at a single teaching hospital in Korea: a retrospective study

Yoon Ji Choi, Seon Uk Han, Seunghoon Woo, Young Jin Ro, Hong Seuk Yang

¹Department of Anesthesiology and Pain Medicine, Seoul Paik Hospital, College of Medicine, Inje University, Seoul, Korea.
²Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea. hsyang@amc.seoul.kr

Received: 12 September 2013 • Revised: 4 February 2014

Abstract

BACKGROUND
This study provides up-to-date survival data on cardiac resuscitation in adult in-patients. The main objectives of the study were to evaluate the incidence, causes, and outcomes of perioperative cardiac arrest. Objective data might encourage more meaningful attitude in anesthesiologists, surgeons, and patients.
METHODS
We retrospectively reviewed patients who experienced perioperative cardiac arrest while receiving noncardiac surgery between January 2004 and December 2012. Collected data included patient characteristics, preoperative evaluations, American Society of Anesthesiologists Physical Status (ASA PS) classification, surgical status (e.g., elective or emergency), type of surgery, and outcomes.
RESULTS
We identified 30 cases of perioperative cardiac arrest that occurred in 457,529 anesthetized patients (incidence = 0.66 per 10,000 anesthetized patient; all-cause mortality = 0.21 per 10,000 anesthetic cases). Two-thirds of patients (19 of 30) were emergency cases (21% survival rate; 4 of 19 patients). Most cardiac arrest patients (60%; 18 of 30 patients) were ASA PS IV-V, and only 40% patients were ASA PS I, II and III. Four cases were associated with anesthesia and the patient recovered, and 3 patients recovered after resuscitation. The main causes of cardiac arrest were respiratory- (75%) and medication-related events (25%).
CONCLUSIONS
In accordance with anesthetic management guidelines and the development of anesthetic agents, anesthesia-related cardiac arrests decreased in terms of incidence and mortality. However, we recommend that clinicians cautiously keep in mind airway management and the administration of medications, which are important preventative factors.

Key Words: Anesthesia, Cardiac arrest, Resuscitation

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