Armstrong R A, Cook T M, Kane A D, Kursumovic E, Nolan J P, Oglesby F C, Cortes L, Taylor C, Moppett I K, Agarwal S, Cordingley J, Davies M T, Dorey J, Finney S J, Kendall S, Kunst G, Lucas D N, Mouton R, Nickols G, Pappachan V J, Patel B, Plaat F, Scholefield B R, Smith J H, Varney L, Wain E, Soar J
Anaesthesia. 2024 Jan;79(1):31-42. doi: 10.1111/anae.16157. Epub 2023 Nov 16.
The 7th National Audit Project of the Royal College of Anaesthetists studied peri-operative cardiac arrest in the UK, a topic of importance to patients, anaesthetists and surgeons. We report the results of the 12-month registry phase, from 16 June 2021 to 15 June 2022, focusing on management and outcomes. Among 881 cases of peri-operative cardiac arrest, the initial rhythm was non-shockable in 723 (82%) cases, most commonly pulseless electrical activity. There were 665 (75%) patients who survived the initial event and 384 (52%) who survived to hospital discharge. A favourable functional outcome (based on modified Rankin Scale score) was reported for 249 (88%) survivors. Outcomes varied according to arrest rhythm. The highest rates of survival were seen for bradycardic cardiac arrests with 111 (86%) patients surviving the initial event and 77 (60%) patients surviving the hospital episode. The lowest survival rates were seen for patients with pulseless electrical activity, with 312 (68%) surviving the initial episode and 156 (34%) surviving to hospital discharge. Survival to hospital discharge was worse in patients at the extremes of age with 76 (40%) patients aged > 75 y and 9 (45%) neonates surviving. Hospital survival was also associated with surgical priority, with 175 (88%) elective patients and 176 (37%) non-elective patients surviving to discharge. Outcomes varied with the cause of cardiac arrest, with lower initial survival rates for pulmonary embolism (5, 31%) and bone cement implantation syndrome (9, 45%), and hospital survival of < 25% for pulmonary embolism (0), septic shock (13, 24%) and significant hyperkalaemia (1, 20%). Overall care was rated good in 464 (53%) cases, and 18 (2%) cases had overall care rated as poor. Poor care elements were present in a further 245 (28%) cases. Care before cardiac arrest was the phase most frequently rated as poor (92, 11%) with elements of poor care identified in another 186 (21%) cases. These results describe the management and outcomes of peri-operative cardiac arrest in UK practice for the first time.
英国麻醉医师皇家学院的第七次全国审计项目研究了英国围手术期心脏骤停情况，这一主题对患者、麻醉师和外科医生都很重要。我们报告了2021年6月16日至2022年6月15日这12个月登记阶段的结果，重点关注管理和结局。在881例围手术期心脏骤停病例中，723例（82%）的初始心律不可电击复律，最常见的是无脉电活动。有665例（75%）患者在初始事件中存活，384例（52%）存活至出院。249例（88%）幸存者报告有良好的功能结局（基于改良Rankin量表评分）。结局因心脏骤停心律而异。缓慢性心脏骤停的存活率最高，111例（86%）患者在初始事件中存活，77例（60%）患者在住院期间存活。无脉电活动患者的存活率最低，312例（68%）在初始事件中存活，156例（34%）存活至出院。年龄极端的患者出院存活率较差，76例（40%）年龄>75岁的患者和9例（45%）新生儿存活。住院存活率也与手术优先级相关，175例（88%）择期手术患者和176例（37%）非择期手术患者存活至出院。结局因心脏骤停原因而异，肺栓塞（5例，31%）和骨水泥植入综合征（9例，45%）的初始存活率较低，肺栓塞（0例）、感染性休克（13例，24%）和严重高钾血症（1例，20%）的住院存活率<25%。464例（53%）病例的总体护理被评为良好，18例（2%）病例的总体护理被评为差。另外245例（28%）病例存在护理不佳的因素。心脏骤停前的护理是最常被评为差的阶段（92例，11%），另有186例（21%）病例发现存在护理不佳的因素。这些结果首次描述了英国实践中围手术期心脏骤停的管理和结局。
