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May 23, 1977

'Cardiac Arrest'

JAMA. 1977;237(21):2287-2288. doi:10.1001/jama.1977.03270480027007

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To the Editor.—  Three parts of the title "Unexpected Cardiac Arrest During Anesthesia and Surgery" (236:2758,1976) lend themselves separately to criticism.First, cardiac arrest is always unexpected; when does one put a patient to sleep and expect that he will die?Second, I have said repeatedly that there is no such disease as cardiac arrest, and that the name should be removed from the literature. If the heart is made to stop because of respiratory obstruction, hypoventilation, anesthetic mismanagement, or embolus, this is all we need to say. It serves no purpose to invent another diagnosis and to say that a mysterious disease struck down the patient. Hearts do not stop without cause and without warning. The incidence of what is called "cardiac arrest" is sometimes the incidence of mind-wandering and inattention, or the incidence of lack of skill or mismanagement. The authors speak of aspiration of vomitus, inappropriate use