Department of Resuscitation Medicine, Warwick Clinical Trials Unit, University of Warwick, Warwick, UK.
Department of Anaesthesia and Intensive Care Medicine, Royal United Hospitals Bath NHS Foundation Trust, Combe Park, Bath, BA1 3NG, UK.
Anaesthesia. 2024 Sep;79(9):914-923. doi: 10.1111/anae.16310. Epub 2024 May 10.
Few existing resuscitation guidelines include specific reference to intra-operative cardiac arrest, but its optimal treatment is likely to require some adaptation of standard protocols.
We analysed data from the 7th National Audit Project of the Royal College of Anaesthetists to determine the incidence and outcome from intra-operative cardiac arrest and to summarise the advanced life support interventions reported as being used by anaesthetists.
In the baseline survey, > 50% of anaesthetists responded that they would start chest compressions when the non-invasive systolic pressure was < 40-50 mmHg. Of the 881 registry patients, 548 were adult patients (aged > 18 years) having non-obstetric procedures under the care of an anaesthetist, and who had arrested during anaesthesia (from induction to emergence). Sustained return of spontaneous circulation was achieved in 425 (78%) patients and 338 (62%) were alive at the time of reporting. In the 365 patients with pulseless electrical activity or bradycardia, adrenaline was given as a 1 mg bolus in 237 (65%). A precordial thump was used in 14 (3%) patients, and although this was associated with return of spontaneous circulation at the next rhythm check in almost three-quarters of patients, in only one of these was the initial rhythm shockable. Calcium (gluconate or chloride) and 8.4% sodium bicarbonate were given to 51 (9%) and 25 (5%) patients, but there were specific indications for these treatments in less than half of the patients. A thrombolytic drug was given to 5 (1%) patients, and extracorporeal cardiopulmonary resuscitation was used in 9 (2%) of which eight occurred during cardiac procedures.
The specific characteristics of intra-operative cardiac arrest imply that its optimal treatment requires modifications to standard advanced life support guidelines.
现有的复苏指南很少有专门针对术中心脏骤停的内容，但这种情况下的治疗可能需要对标准方案进行一些调整。
我们分析了皇家麻醉师学院第 7 次国家审计项目的数据，以确定术中心脏骤停的发生率和结果，并总结了麻醉师报告的使用的高级生命支持干预措施。
在基线调查中，超过 50%的麻醉师表示，当非侵入性收缩压<40-50mmHg 时，他们会开始进行胸外按压。在 881 名登记患者中，有 548 名是成年患者（年龄>18 岁），在麻醉师的监护下接受非产科手术，并且在麻醉期间（从诱导到苏醒）发生了心脏骤停。425 名（78%）患者实现了自主循环的持续恢复，338 名（62%）患者在报告时仍然存活。在 365 名无脉性电活动或心动过缓患者中，237 名（65%）给予了 1mg 肾上腺素推注。14 名（3%）患者使用了心前区叩击，虽然在近四分之三的患者中，下一次节律检查时心搏恢复，但只有 1 名患者的初始节律是可电击的。51 名（9%）和 25 名（5%）患者分别给予了钙（葡萄糖酸盐或氯化物）和 8.4%碳酸氢钠，但不到一半的患者有这些治疗的具体适应证。5 名（1%）患者给予了溶栓药物，9 名（2%）患者进行了体外心肺复苏，其中 8 例发生在心脏手术期间。
术中心脏骤停的特定特征意味着其最佳治疗需要对标准高级生命支持指南进行修改。
