January 1995

Improved Survival After Intraoperative Cardiac Arrest in Noncardiac Surgical Patients

Author Affiliations

From the Department of Surgery, New York (NY) Hospital—Cornell Medical Center.

Arch Surg. 1995;130(1):15-18. doi:10.1001/archsurg.1995.01430010017002

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.(Arch Surg. 1995;130:15-18)