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Prolonged intraoperative cardiac arrest linked to no return of spontaneous circulation

29 Nov 2019
An organ transplant surgery taken place with the “most well-respected manner,” reassures Dr Hirman. Photo credit: Dr Hasdy Haron, clinical manager at National Transplant Resource Centre, Malaysia.

The duration of intraoperative cardiac arrest (ICA) predicts no return of spontaneous circulation (ROSC) after noncardiac surgeries, a recent study has shown.

Researchers analysed 167,574 anaesthetic procedures leading to 160 ICA episodes. The corresponding prevalence was 9.54 cases per 10,000 anaesthesia procedures. Fifty-six patients failed to achieve ROSC, with a case-fatality rate of 35.4 percent. Of those who had ROSC, 30 died within 24 hours and 73 died within one year. The respective case-fatality rates were 29.4 percent and 71.6 percent.

The duration of ICA emerged as a significant predictor of ROSC failure, such that each additional minute correlated with a significant 3-percent increase in risk (adjusted prevalence ratio [PR], 1.03, 95 percent confidence intervals [CI], 1.02–1.04; p<0.001).

Other predictors included hypovolemia as the cause of ICA (adjusted PR, 2.42, 95 percent CI, 1.52–3.86; p<0.001) and hypotension upon admission (adjusted PR, 1.60, 95 percent CI, 1.07–2.40; p=0.022).

Each additional minute of intraoperative ICA was also a significant predictor of greater mortality risk within 24 hours (adjusted PR, 1.04, 95 percent CI, 1.03–1.06; p<0.001) and 1 year (adjusted PR, 1.01, 95 percent CI, 1.01–1.04; p=0.048).

Receiver operating characteristic curve analysis found that at a threshold of 13 minutes, ICA proved the be the strongest independent predictor of no ROSC, with an area under the curve (AUC) of 0.867. The AUCs of ICA cause (0.737; p=0.04) and hypotension upon admission (0.610; p<0.001) were both significantly lower in comparison.

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Most Read Articles
01 Nov 2019
Women with hypertensive disorders of pregnancy, especially pre-eclampsia, are at heightened risk of developing cardiovascular disorder and chronic hypertension, with the risk becoming apparent soon after pregnancy, a study has found.
Roshini Claire Anthony, 29 May 2019

Gestational diabetes and abnormal glucose levels in pregnancy, as determined with an oral glucose challenge test (OGCT) at 24–28 weeks gestation, could signal a future risk of cardiovascular disease (CVD)*, according to a recent study.

07 Jul 2019
Plasma creatinine kinase activity, measure during early pregnancy, influences blood pressure during pregnancy and contributes to severe gestational hypertension diagnosed before 34 weeks of gestation, according to a recent study. There is no association between creatinine kinase and other hypertensive disorders during pregnancy.
Pank Jit Sin, 16 Oct 2019
While a diagnosis of cancer is often met with concern and devastation, the same is barely true for heart failure. However, the mortality rate for those suffering from heart failure is worse than some common cancers, such as prostate and breast cancers.