Objective: To investigate the incidence, characteristics, and outcomes of intraoperative cardiac arrest (IOCA) and identify risk factors for death in IOCA patients.

Materials and Methods: The present study was a retrospective descriptive study at Srinagarind Hospital, a tertiary care university hospital. Anesthesia incident reports between 2016 and 2020 were screened, and IOCA reports were identified. Demographics, characteristics, causes, antecedents within 24 hours of the operation, rate of return of spontaneous circulation (ROSC), and survival outcomes were among the data collected. Logistic regression analysis was used to identify the factors associated with death in IOCA patients.

Results: During the present study period, 67 IOCAs occurred out of 91,139 anesthetics, with an incidence of 7.3 per 10,000 anesthetics. The incidence of IOCA was high in patients with the American Society of Anesthesiologists Physical Status (ASA-PS) 4 and 5 at 103.9 and 1337.6 per 10,000 anesthetics, respectively. The majority of IOCAs occurred during anesthesia maintenance (61.7%) and the initial electrocardiogram (EKG) were non-shockable rhythms (77.6%). The main cause of IOCA was poor patient conditions (46.3%). At the time of ICU discharge, 28 patients (41.8%) had survived, with 21 (31.3%) of these achieving full cerebral recovery. The mortality was 39 (58.2%). Patients with ASA-PS 4 or 5 (OR 4.05, 95% CI 1.45 to 11.34), poor patient conditions (OR 2.73, 95% CI 1.06 to 7.54), and non-shockable EKG (OR 9.00, 95% CI 2.23 to 36.33) were significant risk factors for death in IOCA patients, according to the univariate analysis. Only non-shockable EKG (adjusted OR 6.98, 95% CI 1.15 to 42.47) was found to be a significant risk factor for mortality after multivariate analysis.

Conclusion: Although IOCA was uncommon, it was associated with a high mortality rate. The highest rate of IOCA was found in ASA-PS 5. The main cause of IOCA was poor patient condition. Non-shockable EKG increased the risk of death in IOCA.

Keywords: Incidence study; Intraoperative; Cardiac arrest; IOCA

DOI: 10.35755/jmedassocthai.2022.05.13301

Received 6 December 2021 | Revised 9 February 2022 | Accepted 14 February 2022