Peri-operative cardiac arrest: management and outcomes of patients analysed in the 7th National Audit Project of the Royal College of Anaesthetists

R A Armstrong, T M Cook*, A D Kane, E Kursumovic, J P Nolan, F C Oglesby, L Cortes, C Taylor, I K Moppett, S Agarwal, J Cordingley, M T Davies, J Dorey, S J Finney, S Kendall, G Kunst, D N Lucas, R Mouton, G Nickols, V J PappachanB Patel, F Plaat, B R Scholefield, J H Smith, L Varney, E Wain, J Soar

*Corresponding author for this work

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

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Abstract

The 7th National Audit Project of the Royal College of Anaesthetists studied peri-operative cardiac arrest in the UK, a topic of importance to patients, anaesthetists and surgeons. We report the results of the 12-month registry phase, from 16 June 2021 to 15 June 2022, focusing on management and outcomes. Among 881 cases of peri-operative cardiac arrest, the initial rhythm was non-shockable in 723 (82%) cases, most commonly pulseless electrical activity. There were 665 (75%) patients who survived the initial event and 384 (52%) who survived to hospital discharge. A favourable functional outcome (based on modified Rankin Scale score) was reported for 249 (88%) survivors. Outcomes varied according to arrest rhythm. The highest rates of survival were seen for bradycardic cardiac arrests with 111 (86%) patients surviving the initial event and 77 (60%) patients surviving the hospital episode. The lowest survival rates were seen for patients with pulseless electrical activity, with 312 (68%) surviving the initial episode and 156 (34%) surviving to hospital discharge. Survival to hospital discharge was worse in patients at the extremes of age with 76 (40%) patients aged > 75 y and 9 (45%) neonates surviving. Hospital survival was also associated with surgical priority, with 175 (88%) elective patients and 176 (37%) non-elective patients surviving to discharge. Outcomes varied with the cause of cardiac arrest, with lower initial survival rates for pulmonary embolism (5, 31%) and bone cement implantation syndrome (9, 45%), and hospital survival of < 25% for pulmonary embolism (0), septic shock (13, 24%) and significant hyperkalaemia (1, 20%). Overall care was rated good in 464 (53%) cases, and 18 (2%) cases had overall care rated as poor. Poor care elements were present in a further 245 (28%) cases. Care before cardiac arrest was the phase most frequently rated as poor (92, 11%) with elements of poor care identified in another 186 (21%) cases. These results describe the management and outcomes of peri-operative cardiac arrest in UK practice for the first time.

Original languageEnglish
JournalAnaesthesia
Early online date16 Nov 2023
DOIs
Publication statusE-pub ahead of print - 16 Nov 2023

Bibliographical note

Funding Information:
The project infrastructure was supported financially and with staffing from the Royal College of Anaesthetists. The NAP7 fellows' salaries were supported by: South Tees Hospitals NHS Foundation Trust (AK); Royal United Hospitals Bath NHS Foundation Trust (EK); and NIHR Academic Clinical Fellowship (RA). Additional NAP7 Steering Panel members: C. Bouch and K. Samuel. Panel members received travel expenses and no remuneration. JS and TC's employers receive backfill for their time on the project (4 h per week). IM and SA are Editors of . No other conflicts of interests declared. Anaesthesia

Publisher Copyright:
© 2023 The Authors. Anaesthesia published by John Wiley & Sons Ltd on behalf of Association of Anaesthetists.

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