Cardiac Arrest in the Operating Room: Resuscitation and Management for the Anesthesiologist: Part 1

Vivek K. Moitra, MD; Sharon Einav, MD; Karl-Christian Thies, MD; Mark E. Nunnally, MD; Andrea Gabrielli, MD; Gerald A. Maccioli, MD; Guy Weinberg, MD; Arna Banerjee, MD; Kurt Ruetzler, MD; Gregory Dobson, MD; Matthew D. McEvoy, MD; Michael F. O'Connor, MD, FCCM


Anesth Analg. 2018;126(3):876-888. 

In This Article

Perioperative Cardiac Arrest Outcomes

Over the past 5 years, multiple studies have reported increased survivorship after perioperative arrest compared to arrests in the general population or on inpatient hospital wards.[7,10,14–16] Another study of surgical patients reported encouraging survival statistics, with the lowest survivorship (<20%) among patients who were elderly, had higher American Society of Anesthesiologists status, emergency procedures, contaminated wounds, and high preoperative dependency.[17] Previous observations of lower survivorship after cardiac arrest at night and on weekends have been replicated.[16,18,19] Perhaps paradoxically, survivorship and neurologic outcomes from cardiac arrest are better when they occur in the postanesthesia care unit as compared to the operating room or intensive care unit. This may be related to the different etiologies leading to arrest in that setting.[16]

A recently published analysis of cardiac arrest data from the National Anesthesia Clinical Outcomes Registry revealed that the incidence of cardiac arrest associated with anesthesia is approximately 5.6 per 10,000 cases (951 arrests in 1,691,472 cases), which is considerably lower than previous estimates.[20,21] This analysis also observed that the rate of cardiac arrest increased with age and American Society of Anesthesiologists physical status. Unexpectedly, the study reported a higher rate of cardiac arrest and death among males. A recent study of patients who experienced cardiac arrest within 24 hours of surgery found that asystole was the most common cardiac arrest rhythm.[16] Survivorship after asystole in the perioperative period, however, is significantly higher (30.5%–80%) compared to survivorship after inpatient asystolic arrest (10%).[7,16,22]