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doi: 10.1097/ALN.0000000000000313
Perioperative Medicine: Clinical Science

Predictors of Functional Outcome after Intraoperative Cardiac Arrest

Constant, Anne-Laure M.D.; Montlahuc, Claire M.D.; Grimaldi, David M.D., Ph.D.; Pichon, Nicolas M.D.; Mongardon, Nicolas M.D.; Bordenave, Lauriane M.D.; Soummer, Alexis M.D.; Sauneuf, Bertrand M.D.; Ricome, Sylvie M.D.; Misset, Benoit M.D., Ph.D.; Schnell, David M.D.; Dubuisson, Etienne M.D.; Brunet, Jennifer M.D.; Lasocki, Sigismond M.D., Ph.D.; Cronier, Pierrick M.D.; Bouhemad, Belaid M.D., Ph.D.; Loriferne, Jean-François M.D.; Begot, Emmanuelle M.D.; Vandenbunder, Benoit M.D.; Dhonneur, Gilles M.D., Ph.D.; Bedos, Jean-Pierre M.D., Ph.D.; Jullien, Philippe M.D.; Resche-Rigon, Matthieu M.D., Ph.D.; Legriel, Stephane M.D.

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Background: Few outcome data are available about intraoperative cardiac arrest (IOCA). The authors studied 90-day functional outcomes and their determinants in patients admitted to the intensive care unit after IOCA.
Methods: Patients admitted to 11 intensive care units in a period of 2000–2013 were studied retrospectively. The main outcome measure was a day-90 Cerebral Performance Category score of 1 or 2.
Results: Of the 140 patients (61 women and 79 men; median age, 60 yr [interquartile range, 46 to 70]), 131 patients (93.6%) had general anesthesia, 80 patients (57.1%) had emergent surgery, and 73 patients (52.1%) had IOCA during surgery. First recorded rhythms were asystole in 73 patients (52.1%), pulseless electrical activity in 44 patients (31.4%), and ventricular fibrillation/ventricular tachycardia in 23 patients (16.4%). Median times from collapse to cardiopulmonary resuscitation and return of spontaneous circulation were 0 min (0 to 0) and 10 min (5 to 20), respectively. Postcardiac arrest shock was identified in 114 patients (81.4%). Main causes of IOCA were preoperative complications (n = 46, 32.9%), complications of anesthesia (n = 39, 27.9%), and complications of surgical procedures (n = 36, 25.7%). On day 90, 63 patients (45.3%) were alive with Cerebral Performance Category score 1/2. Independent predictors of day-90 Cerebral Performance Category score 1/2 were day-1 Logistic Organ Dysfunction score (odds ratio, 0.78 per point; 95% CI, 0.71 to 0.87; P = 0.0001), ventricular fibrillation/tachycardia as first recorded rhythm (odds ratio, 4.78; 95% CI, 1.38 to 16.53; P = 0.013), and no epinephrine therapy during postcardiac arrest syndrome (odds ratio, 3.14; 95% CI, 1.29 to 7.65; P = 0.012).
Conclusions: By day 90, 45% of IOCA survivors had good functional outcomes. The main outcome predictors were directly related to IOCA occurrence and postcardiac arrest syndrome; they suggest that the intensive care unit management of postcardiac arrest syndrome may be amenable to improvement.

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