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 Pappachan; B Patel; F Plaat; B R Scholefield; J H Smith; L Varney; E Wain; J Soar; collaborators

doi:10.1111/anae.16157

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

Anaesthesia. 2024 Jan;79(1):31-42. doi: 10.1111/anae.16157. Epub 2023 Nov 16.

Collaborators

collaborators:
N Ahmed, R Ingham, T Hall, T Hall, N Shah, E Tyson, M Wattie, A Ahmed, S Bajaj, R Bassi, A Bennett, N Egbuonu, P Khan, J Lambert, O McKinney, M Mittal, R Rathod, D Riddle, N Sudhan, N Ul Haq, J Balogova, C Bouts, M du Toit, B Gohil, S Ioannidis, S Dubey, L Crawford, B Hockenhull, G Illingworth, J Sanders, I Amin, D Fraser, L Godfrey, M Laurenson, E Osorio, M Rakic, S Thiunagari, A Tulloch, K Apostolidou, M Leong, P Murphy, A Antoniou-Fenwick, D Payam Bahadori, L Orgar, R Basavarajappa, D Swetman, V Bafitis, D Caldow, R Khade, R Mallah, N Piddock, O Tolson, C Chan, Y Mahmoud, S McFerran, S Vanapalli, A Monnickendam, J Pease, R Devlin, J Dumesh, A Kendall, S Thomas, P Chinduluri, F Saddington, A Selman, A Tan, R John, C Timmons, C Clarke, Z Milovanovic, R Smith, E Sousi, I Tribe, J Waiting, H Lamont, J Simon, K Wimble, K Chava, A Guirguis, R Hughes, A Mandal, M Morgan, V Waugh, J Webb, P Efthymiou, A Pitcher, S Rabaas, A Rabie, R Alder, S Butt, S Eswarappa, L Friedman, L Hynes, D Padman, S Shah, S Wood-Gismera, J Bem, V Boardman, A Elhodaiby, L MacNally, J Pippalapalli, R Rowe, N Stannard, S Turvill, J Brett, D Funnell, J Lawson, S Mohan, K Rhodes, D Pearson, R Ramsaran, S Shankar, L Shepherd, A Bhalla, O Henry, H McNamara, A Shah, C Sekhri, M Henwood, R Paramsothy, L Floyd, S Cheung, C Ward, A Gregory, R Phillips, H Rawlins, P Richardson, O Cohen, M Southworth, O Ross-Smith, S Patel, R Rebello, F Chin, M Manolis, S Park, Z Brown, J Mclean, J Gladwin, A Mann, R Mason, P Shetty, R Etomi, R Mall, R Benlloch, R Ghani, S Guha, S Hyder, A Kadiwar, C King, S Murdoch, P Thyveetil, E Fisher, H Brambley, D Crockett, J Cudlipp, A Dor, J Herdman, V Himic, V Himic, F Jegede, T Jones, V Kerner, K Kumar, Y Mahmoud, R Medlock, G Niblett, L Oakley, M Rahman, S Salim, S Shiels, E Derby, S Privalov, O Keating, S Ng, L Alvaro-Gracia, B Baljekar, P Howells, S Kajal, H Mohd Noor Nur, R Child, G Clarke, L Elvidge, S Gill, K Harland-Mears, W Jones, A McArdle, R Phillips, C Tilsley, V Chiappa, W Foers, E Haines, A Hunter, L Jones, A Lavin, L Markham, P Ong, R Wilcock, M Abayalingam, C Baker, T Bemand, A Chauhan, C Hensher, A Lakhani, G Patil, C Rowe, J Sumit Vaghani, U Kidwai, V Venkat Raman, V Padmanabhan, A Weir, A Casement, D O'Connor, S Antrolikar, D Dhaka, K Diridis, N Kordmahalleh, P Ramamurthi, S Salim, C Shin, D Wilson, A Rajkumar, A Adigwe, H Cullumbine, A Alim Khan, A Old, T O'Pray, P Smith, J Carter, M Edmondson, B Eldridge, A Gordon, C Hunter, R Pugsley, T Richards, K Saunders, S Steynberg, V Amin, T Anthony Pynadath, A Shah, F Makin, P Kadaramandalgi, V Lowden, B Marshall, N Oldrey, A Wheeler, L Prinz Zu Salm-Horstmar, S Tahir, J Taylor, J Avula, R Bains, K Dhamodaran, Y Soon, M Lehra, J Orr, M Arshad, A Balu, A Bhat, R Khunti, R Moss, L Quffa, D Sannakki, S Sannakki, J Yeung, K Sweet, C Webb, J Fearnley, M Hodgetts, B Patel, T Trouton, A Yasin, A Cash, A Nash, W Smith, D Nigalye, L Freeman, H Jennison, A Lee, D Viira, L Gallop, E Hobbiger, E Lusby, L Allan, A Knight, A McConville, N Granger, A Knight, A Martin, N Sexton, T Patel, A Hatalyak, M Ince, O Afelumo, C Gardiner, V Nirmalan, S Mease, M Morawski, C Robinson-Lynch, T Trynka-Watson, J Hollands, C Warden, V Withey, A Leonard, S Parsons, S Jones, T Rebello, D Yule, J Adams, Nick Black, Hannah Cooper, Peter Currie, C Curry, D Donnelly, S Marcus, J McCarter, M McDowell, S McGuirk, R McMullan, C Munn, M Nugdallah, P Pyper, J Stewart, N Sweeney, G Wallace, K Barrett, G Best, M Ferguson, S Gilliland, L McDowell, D Wright, A McCallum, R Vidion, R Harvey, M Bell, A Burden, J Doverty, A Muir, M Zikry, P Forget, N Nagdeve, E Chalmers, M Tait, R Karve, N Roy, S Gambhir, W Gaunt, J Lau, K McAleer, T Murphy, C O'Brien, M Sweeney, V Mei-Ling Chang, M Keller, M Kellner, A Macaskill Stewart, S Mackie, V Mei-Ling Chang, S Omar, D Blacoe, D Paal, R Tallach, R Dryden, L Meney, J Neil, L Valentine, N Albuquerque, M Casey, G Findlay, H Hare, E Mann, R McCusker, S Morrison, M Pass, R Patel, R Seatter, L Thompson, A Thornback, I McConachie, A Dalton, J Exley, K Foxwell, B Jones, M Magoub, O Smith, N Zalkapli, C Jones, R Bond, M Burton, T Hawkins, P Rogers, J Westwood, R Dhaliwal, P Ganesan, A Mekhael, S Rajaratnam, P Data, J Fox, L Kaur

PMID: 37972480
DOI: 10.1111/anae.16157

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.

Keywords: NAP7; anaesthesia; peri-operative cardiac arrest.

MeSH terms

Anesthetists
Cardiopulmonary Resuscitation* / methods
Heart Arrest* / epidemiology
Heart Arrest* / therapy
Humans
Infant, Newborn
Pulmonary Embolism*
Registries

Grants and funding

Royal College of Anaesthetists