University of Manchester, Manchester, UK.
Department of Anaesthesia and Critical Care, Manchester University NHS Foundation Trust, Manchester, UK.
Anaesthesia. 2024 Nov;79(11):1212-1219. doi: 10.1111/anae.16413. Epub 2024 Aug 22.
The 7th National Audit Project of the Royal College of Anaesthetists studied peri-operative cardiac arrest because of existing knowledge gaps in this important topic. This applies in particular to cardiology patients receiving anaesthetic care, because numbers, types and complexity of minimally invasive interventional procedures requiring planned and unplanned anaesthesia in the cardiac intervention suite is increasing.
We analysed collected data to determine the epidemiology, clinical features, management and outcomes of peri-operative cardiac arrest in adult patients receiving anaesthetic care for cardiology procedures.
There were 54 reports of peri-operative cardiac arrest in adult patients receiving anaesthetic care for cardiology procedures, accounting for 54/881 (6.1%) of all reports to NAP7. The estimated incidence (95%CI) of cardiac arrests in this group was 1/450 or 0.22 (0.17-0.29)%. These patients were older than other adult patients in the NAP7 population, with a notably high proportion of patients of Asian ethnicity when compared with the remaining NAP7 cohort (9/54, 17% vs. 35/709, 5%). Rates of extracorporeal membrane oxygenation cardiopulmonary resuscitation were low (3/53, 6%). A common theme was that of logistical issues and teamworking, with reporters commenting on the difficulties of remote and/or unfamiliar locations and communication issues between specialties, on occasion resulting in poor teamworking and a lack of focus. The NAP7 panel review identified several other common themes which included: cardiogenic shock; late involvement of anaesthesia in the case; and transcatheter aortic valve implantation.
Cardiology procedures requiring anaesthesia care account for < 1% of anaesthesia activity but generate 6% of all peri-operative cardiac arrests. The incidence of cardiac arrest was disproportionately high in cardiological procedures requiring anaesthetic care. The nature of the cardiac arrest reports to NAP7 indicate that logistical and human factors in multidisciplinary teams in the cardiac intervention suite merit addressing to improve care.
皇家麻醉师学院的第 7 次国家审计项目研究了围手术期心脏骤停，因为在这个重要主题上存在知识空白。这尤其适用于接受麻醉护理的心脏病患者，因为需要计划和非计划麻醉的微创介入程序的数量、类型和复杂性在心脏介入套房中不断增加。
我们分析了收集的数据，以确定接受心脏病学手术麻醉护理的成年患者围手术期心脏骤停的流行病学、临床特征、管理和结果。
在接受心脏病学手术麻醉护理的成年患者中，有 54 例围手术期心脏骤停报告，占 NAP7 所有报告的 54/881（6.1%）。该组心脏骤停的估计发生率（95%CI）为 1/450 或 0.22（0.17-0.29）%。这些患者比 NAP7 人群中的其他成年患者年龄更大，与 NAP7 队列中的其余部分相比，亚洲裔患者的比例明显更高（9/54，17%比 35/709，5%）。体外膜氧合心肺复苏的比例较低（3/53，6%）。一个共同的主题是后勤问题和团队合作，报告者评论了远程和/或不熟悉的地点以及专业之间沟通的困难，有时导致团队合作不佳和缺乏重点。NAP7 小组审查还确定了其他一些共同主题，包括：心源性休克；麻醉在病例中晚期介入；以及经导管主动脉瓣植入术。
需要麻醉护理的心脏病学程序占麻醉活动的<1%，但产生了所有围手术期心脏骤停的 6%。需要麻醉护理的心脏病学程序中心脏骤停的发生率不成比例地高。NAP7 报告的心脏骤停性质表明，心脏介入套房中多学科团队的后勤和人为因素值得解决，以改善护理。
