Cardiac arrest of patients during anesthesia has been the driving force behind the development of this specialty. Safer procedures, new anesthetics, and technical improvements such as monitoring devices and ventilators have successfully reduced intraoperative mortality. Nevertheless, modern technology itself creates specific risks; and causes, diagnosis, and management of anesthesia-related cardiac arrest differ considerably from situations encountered elsewhere.
Cardiac arrest attributable to anesthesia occurs from 0.5 to 1 case per 10 000 interventions. Pediatric cases show a higher incidence (1.4–4.6 per 10 000). However, with the increasing age of patients, preexisting disease or trauma, and new surgical interventions cardiac arrests remain a serious concern. Environmental considerations are gradually becoming more important than mere technological improvements, and educational inputs try to create safer surroundings by recognizing human factors such as efficient communication, awareness, error culture, crew resources utilization, and preparedness for more effective crisis management.
The anesthetic environment has become much safer than it was 50 years ago. For a successful management of cardiac arrest during operative procedures, not only individual knowledge and skills but also institutional safety culture have to be implemented into education, training, and everyday practice of this specialty.
Department of Anaesthesia and Intensive Care, University Hospital Basel, Basel, Switzerland
Correspondence to Wolfgang Ummenhofer, MD, Department of Anaesthesia and Intensive Care, University Hospital Basel, CH-4031 Basel, Switzerland