Brown Morgan L, Staffa Steven J, Adams Phillip S, Caplan Lisa A, Gleich Stephen J, Hernandez Jennifer L, Richtsfeld Martina, Riegger Lori Q, Vener David F
Division of Cardiac Anesthesia, Department of Anesthesiology, Critical Care and Pain Medicine, Boston Children's Hospital, Boston, Mass.
Department of Anesthesiology and Perioperative Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pa.
JTCVS Open. 2024 Sep 23;22:427-437. doi: 10.1016/j.xjon.2024.09.015. eCollection 2024 Dec.
To describe intraoperative cardiac arrest in patients undergoing congenital heart surgery.
The Society of Thoracic Surgeons Congenital Heart Surgery Database was queried. Predictors of intraoperative cardiac arrest were assessed using univariate and multivariable analyses. The univariate relationship between intraoperative cardiac arrest was also compared with available outcomes in the database.
A total of 92,764 cases had anesthesia adverse event data, and 357 patients (0.38%) had an intraoperative cardiac arrest. Multivariable predictors of an intraoperative cardiac arrest included age (odds ratio [OR], 0.98 per year; 95% confidence interval [CI], 0.97-0.99; = .036), preoperative cardiac arrest (<48 hours) (OR, 9.6; 95% CI 6.3-14.6, < .001), preoperative neurologic deficit (OR, 2.0; 95% CI, 1.3-3.1, = .002), noninsulin-dependent diabetes mellitus (OR, 6.4; 95% CI, 1.9-21.9, = .003), increasing Society of Thoracic Surgeons-European Association for Cardio-Thoracic Surgery (STAT) category (OR, 2.3 for STAT 5 vs STAT 1; 95% CI, 1.3-3.9, = .003), urgent (OR, 2.0; 95% CI, 1.6-2.6, < .001) or emergent surgery (OR, 3.1; 95% CI, 1.9-5.0, < .001), and increasing length of total operating room time (OR, 1.2 per hour; 95% CI, 1.2-1.3, < .001). Intraoperative cardiac arrest was associated with a greater 30-day mortality (14.6% vs 1.8%, < .001). There were more morbidities in the intraoperative cardiac arrest group including postoperative neurologic deficits (12% vs 1.0%, < .001), multisystem organ failure (5.9% vs 0.7%, < .001), and greater rates of unplanned reoperation (19.3% vs 5.0%, < .001) or interventional cardiac catheterization (7% vs 3.2%, < .001).
The incidence of intraoperative cardiac arrest is low; however, it is an important indicator of significant patient perioperative morbidity and mortality.
描述先天性心脏病手术患者术中心脏骤停的情况。
查询胸外科医师协会先天性心脏病手术数据库。采用单因素和多因素分析评估术中心脏骤停的预测因素。还将术中心脏骤停的单因素关系与数据库中的可用结局进行了比较。
共有92764例病例有麻醉不良事件数据，357例患者（0.38%）发生术中心脏骤停。术中心脏骤停的多因素预测因素包括年龄（比值比[OR]，每年0.98；95%置信区间[CI]，0.97 - 0.99；P = 0.036）、术前心脏骤停（<48小时）（OR，9.6；95% CI 6.3 - 14.6，P < 0.001）、术前神经功能缺损（OR，2.0；95% CI，1.3 - 3.1，P = 0.002）、非胰岛素依赖型糖尿病（OR，6.4；95% CI，1.9 - 21.9，P = 0.003）、胸外科医师协会-欧洲心胸外科协会（STAT）分类增加（STAT 5与STAT 1相比，OR，2.3；95% CI，1.3 - 3.9，P = 0.003）、急诊（OR，2.0；95% CI，1.6 - 2.6，P < 0.001）或紧急手术（OR，3.1；95% CI，1.9 - 5.0，P < 0.001）以及总手术室时间延长（OR，每小时1.2；95% CI，1.2 - 1.3，P < 0.001）。术中心脏骤停与30天死亡率较高相关（14.6%对1.8%，P < 0.001）。术中心脏骤停组的并发症更多，包括术后神经功能缺损（12%对1.0%，P < 0.001）、多系统器官衰竭（5.9%对0.7%，P < 0.001）以及计划外再次手术（19.3%对5.0%，P < 0.001）或介入性心脏导管插入术（7%对3.2%，P < 0.001）的发生率更高。
术中心脏骤停的发生率较低；然而，它是患者围手术期严重发病和死亡的重要指标。
