Cardiac arrest in vascular surgical patients receiving anaesthetic care: an analysis from the 7th National Audit Project (NAP7) of the Royal College of Anaesthetists

R A Armstrong, T M Cook, G Kunst, A D Kane, E Kursumovic, D N Lucas, G Nickols, J Soar, Ronelle Mouton*

*Corresponding author for this work

Research output: Contribution to journalArticle (Academic Journal)peer-review

1 Citation (Scopus)

Abstract

The 7th National Audit Project of the Royal College of Anaesthetists studied peri-operative cardiac arrest in the UK. We report the results of the vascular surgery cohort from the 12-month case registry, from 16 June 2021 to 15 June 2022. Anaesthesia for vascular surgery accounted for 2% of UK anaesthetic caseload and included 69 (8%) reported peri-operative cardiac arrests, giving an estimated incidence of 1 in 670 vascular anaesthetics (95%CI 1 in 520–830). The high-risk nature of the vascular population is reflected by the proportion of patients who were ASA physical status 4 (30, 43%) or 5 (19, 28%); the age of patients (80% aged > 65 y); and that most cardiac arrests (57, 83%) occurred during non-elective surgery. The most common vascular surgical procedures among patients who had a cardiac arrest were: aortic surgery (38, 55%); lower-limb revascularisation (13, 19%); and lower-limb amputation (8, 12%). Among patients having vascular surgery and who had a cardiac arrest, 28 (41%) presented with a ruptured abdominal aortic aneurysm. There were 48 (70%) patients who had died at the time of reporting to NAP7 and 11 (16%) were still in hospital, signifying poorer outcomes compared with the non-vascular surgical cohort. The most common cause of cardiac arrest was major haemorrhage (39, 57%), but multiple other causes reflected the critical illness of the patients and the complexity of surgery. This is the first analysis of the incidence, management and outcomes of peri-operative cardiac arrest during vascular anaesthesia in the UK.
Original languageEnglish
Pages (from-to)506-513
Number of pages8
JournalAnaesthesia
Volume79
Issue number5
Early online date4 Jan 2024
DOIs
Publication statusE-pub ahead of print - 4 Jan 2024

Bibliographical note

Funding Information:
The project infrastructure is supported financially and with staffing from the Royal College of Anaesthetists. Other NAP7 panel and team members are: S. Agarwal; J. Cordingley; L. Cortes; M. T. Davies; J. Dorey; S. J. Finney; S. Kendall; J. Lourtie; I. K. Moppett; J. P. Nolan; F. C. Oglesby; V. J. Pappachan; B. Patel; F. Plaat; K. Samuel; B. R. Scholefield; J. H. Smith; C. Taylor; L. Varney; and E. Wain. We thank all NAP7 local reporters and their teams and all UK anaesthetists who completed surveys or submitted cases. The NAP7 fellows' salaries were supported by: South Tees Hospitals NHS Foundation Trust (AK); Royal United Hospitals Bath NHS Foundation (EK); NIHR Academic Clinical Fellowship (RA). Panel members receive travel expenses and no remuneration. JS and TC's employers receive backfill for their time on the project (4 hours per week). We thank the HSRC/RCoA research team including K. Williams (Audit Co‐ordinator), J. Lourtie (Head of Research) and S. Drake (Director of Clinical Quality and Research) for supporting and collaborating on the project. Special thanks to S. Waton from the Clinical Effectiveness Unit, Royal College of Surgeons of England, for providing data from the National Vascular Registry on the annual number of surgeries for ruptured abdominal aortic aneurysm. SA and IM are editors of . No other competing interests declared. Anaesthesia

Publisher Copyright:
© 2024 The Authors. Anaesthesia published by John Wiley & Sons Ltd on behalf of Association of Anaesthetists.

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