Perioperative cardiac arrest: an evolutionary analysis of the intra-operative cardiac arrest incidence in tertiary centers in Brazil

Vane, Matheus Fachini; Nuzzi, Rafael Ximenes do Prado; Aranha, Gustavo Fabio; Luz, Vinicius Fernando da; Malbouisson, Luiz Marcelo Sá; Gonzalez, Maria Margarita Castro; Auler, José Otávio Costa; Carmona, Maria José Carvalho

doi:10.1016/j.bjane.2014.06.007

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REVIEW ARTICLE • Rev. Bras. Anestesiol. 66 (2) • Mar-Apr 2016 • https://doi.org/10.1016/j.bjane.2014.06.007 copy

Perioperative cardiac arrest: an evolutionary analysis of the intra-operative cardiac arrest incidence in tertiary centers in Brazil

Authorship SCIMAGO INSTITUTIONS RANKINGS

ABSTRACT

BACKGROUND:

Great changes in medicine have taken place over the last 25 years worldwide. These changes in technologies, patient risks, patient profile, and laws regulating the medicine have impacted the incidence of cardiac arrest. It has been postulated that the incidence of intraoperative cardiac arrest has decreased over the years, especially in developed countries. The authors hypothesized that, as in the rest of the world, the incidence of intraoperative cardiac arrest is decreasing in Brazil, a developing country.

OBJECTIVES:

The aim of this study was to search the literature to evaluate the publications that relate the incidence of intraoperative cardiac arrest in Brazil and analyze the trend in the incidence of intraoperative cardiac arrest.

There were 4 articles that met our inclusion criteria, resulting in 204,072 patients undergoing regional or general anesthesia in two tertiary and academic hospitals, totalizing 627 cases of intraoperative cardiac arrest. The mean intraoperative cardiac arrest incidence for the 25 years period was 30.72:10,000 anesthesias. There was a decrease from 39:10,000 anesthesias to 13:10,000 anesthesias in the analyzed period, with the related lethality from 48.3% to 30.8%. Also, the main causes of anesthesia-related cause of mortality changed from machine malfunction and drug overdose to hypovolemia and respiratory causes.

CONCLUSIONS:

There was a clear reduction in the incidence of intraoperative cardiac arrest in the last 25 years in Brazil. This reduction is seen worldwide and might be a result of multiple factors, including new laws regulating the medicine in Brazil, incorporation of technologies, better human development level of the country, and better patient care.

Keywords:
Intra-operative complications; Heart arrest; Cardiopulmonary resuscitation; Anesthesia

Author	Period	Location of data collection	Design	n	ICA	Monitor
Ruiz Neto, RBA 1986 (REF)	1982–1984	Hospital das Clínicas, Faculty of Medicine, University of Sao Paulo, Sao Paulo, Sao Paulo State, Brazil (Tertiary Academic Hospital)	Retrospective	51,422 (38,652 electives and 12,770 emergencies)	- 205 cases - Incidence: 39: 10,000 - 75.1% urgencies - 24.9% electives	NIBP ECG
Braz RBA 1999	1988–1996	Botucatu School of Medicine University Hospital, Sao Paulo State University, Botucatu, Sao Paulo State, Brazil	Retrospective	58,553	- 184 cases - Incidence: 31.42:10,000 - 68% urgencies - 32% electives	Not Specified
Braz BJA 2006	1996–2005	Botucatu School of Medicine University Hospital, Sao Paulo State University, Botucatu, Sao Paulo State, Brazil	- Prospective with mandatory quality check	53,718 – includes cardiac surgeries	186 cases 34.6:10,000 - 68% urg - 32% electives	NIBP EKG SpO₂ Et CO₂ Conc O₂ Gas analysis Ventilometer
Sebbag SPMJ 2013	2007	Hospital das Clínicas, Faculty of Medicine, University of Sao Paulo, Sao Paulo, Sao Paulo State, Brazil (Tertiary Academic Hospital)	- Prospective	40,379	52 cases (13:10,000) - 29% electives - 71% urgencies	NIBP EKG SpO₂ Et CO₂ Conc O₂ Gas analysis Ventilometer

Author	Mortality (:10,000)	Lethality (deaths divided by CA)	CPR and OR outcome	Causes of ICA	Results
Ruiz Neto, RBA 1986 (REF)	- Electives 2: 10,000 - Urgency 70:10,000	Anesthetic: 12% Surgical: 76.3% Physical Status: 46.4%	ROSC electives: 83.4% Urgency ROSC: 41.6%. After ROSC: 59.4% Bad overall status (OS), 40.6% Good and Regular OS. Those with anesthetic cause: 47% good and regular OS.	- Elective surgeries: mostly anesthesia-related (76.5%) - Urgency mostly surgical-related (59.7%)	- Urgencies > electives - Related factors: Gender (male), age (elder), clinic (general surgery), moment (maint),
Braz RBA 1999	- 21.17:10,000 - Cause: Physical status: 15.71:10,000 - Surgical: 4.61:10,000 - Anesthetic: 0.85:10,000	Anesthetic 23.8% Surgical 58.7% Physical status 78.6%	After ROSC: 55% Bad OS, 20% regular OS and 25% in good OS. Those with anesthetic cause: 71% good OS.	- Physical Status 19.98 CPA: 10,000 (anesthetics) - Anesthetics: 3.59:10,000 Surgical: 7.86:10,000	- 88.59% in the OR - Factors: age (elder), gender (male), Physical Status 3 or higher, urgency, general anest.
Braz BJA 2006	-21.97:10,000 - Cause: Physical status: 14.89:10,000 - Surgical: 5.96:10,000 - Anesthetic: 1.12:10,000	Anesthetic: 33.3% Surgical 68.1% Physical status 66.1%	Not specified	- Defined by CPAs commission: - Anesthetics: 3.35:10,000 - Surgical patient: 8.75:10,000 - Physical status: 22.52:10,000 Anesthetic: 1 – respiratory (55.6%) 2 – drugs (44.4%)	- OR > PACU (RPA) - Related factors: gender (male), age (newborns, <1 y, 51–64 y), ASA (III or +), urgency, general anest
Sebbag SPMJ 2013	Up to 30 days – 10:10,000	- Overall immediate lethality: 30.8% - 30-days lethality was 75%	- 69% successful CPRs Survivors: - 39% in 24 h - 25% in 30 d - elect 53% - emerg 14%	- Defined retrospectively - Physical status (52%) - Surgical (8%) - Anesthetic (40%)	- Related factors: gender (male) - Physical status (ASA III or +) - Emergency (71%) - General anest (90%)

Years	Overall incidence of cardiac arrest (:10,000)	Incidence of cardiac arrest in emergency cases (:10,000)	Incidence of cardiac arrest in elective cases (:10,000)	Overall lethality
1982–1984	39.0	120.0	13.0	48.3%
1988–1996	31.4	45.4	19.2	67.3%
1996–2005	34.6	55.4	19.4	63.4%
2007	13.0	15.0	5.0	30.8%

Sociedade Brasileira de Anestesiologia R. Professor Alfredo Gomes, 36, 22251-080 Botafogo RJ Brasil, Tel: +55 21 2537-8100, Fax: +55 21 2537-8188 - Campinas - SP - Brazil
E-mail: bjan@sbahq.org

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[1] * Corresponding author. E-mail:mfvane@uol.com.br (M.F. Vane).

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Perioperative cardiac arrest: an evolutionary analysis of the intra-operative cardiac arrest incidence in tertiary centers in Brazil

ABSTRACT

BACKGROUND:

OBJECTIVES:

CONTENTS:

CONCLUSIONS: