Improved survival after intraoperative cardiac arrest in noncardiac surgical patients
L. N. Girardi and P. S. Barie
Department of Surgery, New York Hospital, Cornell Medical Center, NY.
OBJECTIVE: To test the hypothesis that improvements in intraoperative and
perioperative critical care are resulting in an improved outcome after
intraoperative cardiac arrest. DESIGN: A retrospective consecutive series
of patients who experienced an intraoperative cardiac arrest during
noncardiothoracic surgical procedures between January 1986 and June 1994.
SETTING: A tertiary care university-based hospital. PARTICIPANTS:
Twenty-four consecutive patients who experienced an intraoperative arrest
among 162,661 noncardiothoracic surgical procedures during the designated
period. INTERVENTION: Advanced cardiac life support and advanced trauma
life support methods were used appropriately. Postarrest pharmacologic and
mechanical cardiopulmonary support were used as needed in the setting of a
surgical intensive care unit. MAIN OUTCOME MEASURES: Survival out of the
operating room and survival to discharge. RESULTS: Fifteen patients (62%)
were resuscitated in the operating room and taken to the surgical intensive
care unit or recovery room. Nine patients (38%) survived to discharge from
the hospital. Twelve arrests (50%) were primarily cardiac in origin.
Predictors of mortality included a need for pressor or inotropic support (P
< .001) and duration of the arrest greater than 15 minutes (P <
.001). CONCLUSION: Survival from an intraoperative cardiac arrest in a
noncardiothoracic surgical patient is much improved over rates in
historical controls who experienced in-hospital and out-of-hospital cardiac
arrest. Rapid identification and aggressive correction of mechanical and
metabolic derangements is warranted.
