Yong Jonathan, Hibbert Peter, Runciman William B, Coventry Brendon J
Discipline of Surgery, University of Adelaide, Royal Adelaide Hospital, Adelaide, Australia.
The Australian Institute of Health Innovation, University of New South Wales, Sydney, Australia.
Int J Qual Health Care. 2015 Dec;27(6):473-8. doi: 10.1093/intqhc/mzv077. Epub 2015 Sep 29.
The aim of this study was to identify clinical patterns of occurrence, management and outcomes surrounding cardiac arrest during laparoscopic surgery using the Australian Incident Monitoring Study (AIMS) database to guide possible prevention and treatment.
The AIMS database includes incident reports from participating clinicians from secondary and tertiary healthcare centres across Australia and New Zealand.
The AIMS database holds over 11 000 peri- and intraoperative incidents.
The primary outcome was to characterize the pattern of events surrounding cardiac arrest. The secondary outcome was to identify successful management strategies in the possible prevention and treatment of cardiac arrest during laparoscopic surgery.
Fourteen cases of cardiac arrest during laparoscopic surgery were identified. The majority of cases occurred in 'fit and healthy' patients during elective gynaecological and general surgical procedures. Twelve cases of cardiac arrest were directly associated with pneumoperitoneum with bradycardia preceding cardiac arrest in 75% of these. Management included deflation of pneumoperitoneum, atropine administration and cardiopulmonary resuscitation with circulatory restoration in all cases. The results imply vagal mechanisms associated with peritoneal distension as the predominant contributor to bradycardia and subsequent cardiac arrest during laparoscopy.
Bradycardia during gas insufflation is not necessarily a benign event and appears to be a critical early warning sign for possible impending and unexpected cardiac arrest. Immediate deflation of pneumoperitoneum and atropine administration are effective measures that may alleviate bradycardia and possibly avert progression to cardiac arrest.
本研究旨在利用澳大利亚事件监测研究（AIMS）数据库确定腹腔镜手术期间心脏骤停的发生、处理及结局的临床模式，以指导可能的预防和治疗措施。
AIMS数据库包含来自澳大利亚和新西兰二级及三级医疗中心参与临床医生的事件报告。
AIMS数据库存有超过11000例围手术期及术中事件。
主要结局是描述心脏骤停相关事件的模式。次要结局是确定在腹腔镜手术期间可能预防和治疗心脏骤停的成功管理策略。
共确定14例腹腔镜手术期间心脏骤停病例。大多数病例发生在择期妇科和普通外科手术中的“健康”患者。12例心脏骤停与气腹直接相关，其中75%在心脏骤停前出现心动过缓。所有病例的处理包括气腹放气、给予阿托品及心肺复苏并恢复循环。结果提示与腹膜扩张相关的迷走神经机制是腹腔镜手术期间心动过缓和随后心脏骤停的主要原因。
充气期间的心动过缓不一定是良性事件，似乎是可能即将发生意外心脏骤停的关键早期预警信号。立即气腹放气和给予阿托品是有效的措施，可能缓解心动过缓并避免进展为心脏骤停。
