The incidence of postoperative cardiac arrest and pre-resuscitation factors associated with post- cardiopulmonary resuscitation mortality: a single-center study in Thailand

Abstract

Background: The author aimed to determine the incidence of in-hospital postoperative cardiac arrest requiring cardiopulmonary resuscitation (CPR), postoperative CPR mortality and pre-resuscitation factors associated with post CPR mortality. Method: A retrospective cohort study was conducted at King Chulalongkorn Memorial Hospital in Thailand from September 2018 through August 2020. A total of 34,590 adult patients underwent surgical procedures under anesthesia were recruited by electronic data recorded review. A subset of patients with postoperative CPR was collected for demographic data, comorbidities, ASA classification, operative time, functional class, types of surgery, postoperative complications, the number of deaths and survival, and SOS score at 4 hours preceding cardiac arrest. Results: A total of 34,590 adult surgical patients were recruited. In-hospital postoperative cardiac arrest incidence was 12 patients per 10,000 surgeries and predominated in emergency operation (28 per 10,000 surgeries; P< 0.0001). Risk ratio of emergency operation resulted in postoperative CPR was 3.15 (95% CI 1.72-5.77; P<0.001). Postoperative cardiac arrest patients aged 64.07 ± 16.58. The BMI was 23.46 ± 5.83. Mostly they were in ASA category 3 (44.2%). Everyone had general anesthetic procedures. The most common comorbidity was hypertension. In-hospital postoperative CPR mortality was 62.8%. Factors possibly predisposed to it were functional class < 4 METS, colorectal surgery and SOS score at 4 hours prior to cardiac arrest of at least 8. Conclusion:  Incidence of in-hospital postoperative cardiac arrest and mortality after CPR in the study tended to be lower than that of previous studies. Emergency operations predisposed to cardiac arrest. SOS score was possibly valuable as a prognostication tool, ICU triage, as well as, a part of the early warning score to prevent the overwhelming crisis. Surveillance for patient’s deterioration, effective rapid response system, and comprehensive preoperative rehabilitation should be emphasized.