(Press-News.org) A new study ‒ that has examined all cardiac arrests occurring during or soon after surgery in more than 300 UK hospitals over a one-year period ‒ has identified that this extremely dangerous and often fatal event occurs in 3 per 10,000 surgeries requiring anaesthesia.
The study - the 7th National Audit Project of the Royal College of Anaesthetists (NAP7) published in Anaesthesia (the journal of the Association of Anaesthetists) – included data from all NHS hospitals and some in the independent sector and received the support of more than 11,000 anaesthetists throughout the UK. It is likely the largest and certainly the most in-depth study of the nature, causes and consequence of perioperative cardiac arrest, perhaps the complication of surgery feared most by patients, anaesthetists and surgeons. The study included detailed review of more than 900 cases of perioperative cardiac arrest, of which 881 were included in the study.
The two research papers are by an extensive collaboration of anaesthetists across the UK, including Dr Richard Armstrong, Severn School of Anaesthesia and University of Bristol, Bristol, UK, Dr Jasmeet Soar, Consultant in Anaesthesia and Intensive Care, North Bristol NHS Trust, Bristol, UK and Professor Tim Cook, Consultant in Anaesthesia and Intensive Care Medicine, Royal United Hospitals Bath NHS Trust, Bath, UK and Honorary Professor, School of Medicine, University of Bristol, UK. The full report is a collaboration led by the Royal College of Anaesthetists (RCoA) and a full report is also published on the RCoA website.
The authors report the results of the 12-month registry, from June 2021 to June 2022, focusing on epidemiology and clinical features. They reviewed 881 cases of cardiac arrest among an annual caseload of 2.71 million anaesthetics, giving an incidence of 3 per 10,000 anaesthetics – lower than other studies from the USA (5.7 per 10,000) and Brazil (13 per 10,000) had estimated.
Incidence varied with patient and surgical factors. Compared with all surgeries, patients who had cardiac arrest were more frequently male (56%) while only 42% of all surgeries were in men. Increased risk was also shown for the very old and very young: 25% of cardiac arrests occurred in people over 75 years, while only 13% of patients were in this age group; and 8% of cardiac arrests occurred in children aged under 1 year, while only 1% of total patients were in this age group.
Compared with the overall population undergoing anaesthesia, those experiencing cardiac arrest were more often ill or had other significant medical conditions and less often healthy. Patients who were ill or had significant medical conditions (ASA physical status 4–5) accounted for 37% of cardiac arrests but only 4% of the surgical population, whereas healthy patients (ASA physical status 1-2) accounted for 26% of those who had a cardiac arrest and 73% of the surgical population.
Compared with the overall population undergoing anaesthesia, patients who had cardiac arrest were more likely to be undergoing emergency surgery (65% of cardiac arrests occurred during emergency surgery but only 30% of all cases were emergency). Similarly, 60% of the cardiac arrests happened during complex surgery while only 28% of cases were classed as complex. Timing of surgery also mattered: 14% of cardiac arrests occurred during the weekend (Saturday/Sunday), while only 11% of all surgeries were during the weekend; and 19% of cardiac arrests occurred out-of-hours (1801H-0759H), while only 10% of all surgeries were out of hours.
The highest number of cardiac arrests occurred during orthopaedic trauma surgery (12% of all cardiac arrests), major abdominal surgery (10%), cardiac surgery (9%) and vascular surgery (8%). When adjusted for the annual caseload in each specialty, those with the highest risk of cardiac arrest were cardiac surgery (9-fold excess risk), cardiology procedures requiring anaesthetic care (8-fold) and vascular surgery (4-fold).
The most common causes of cardiac arrest were major bleeding (causing 17% of cardiac arrests), very slow heart rate (9%), and cardiac ischaemia (lack of oxygen delivered to the heart) (7%). The authors explored whether the cardiac arrest was due to underlying patient chronic and current ill health or due to anaesthesia or surgery, finding that key factors were the patient’s condition in 82% of cases, anaesthesia in 40% and surgery in 35%. Examples of patient factors include frailty, severe underlying disease and bleeding; examples of surgical factors include complex surgery complicated by bleeding; and anaesthesia examples include a severe allergic reaction to administered drugs.
The authors explain that the study data “highlight a complex interaction of patient, surgical and anaesthetic factors in many perioperative cardiac arrests” also noting that “the cause of cardiac arrest varied widely in different surgical specialties.” The study also showed high rates of senior staff involvement in cases of cardiac arrest.
Reassuringly in healthy (ASA physical status 1) patients undergoing routine surgery, the study showed the rarity of cardiac arrest with this event occurring in fewer than 1 in 10,000 cases and death in 1 in 132,000.
Professor Cook says: “The finding that in more than 80% of all cases, and three-quarters of those occurring at night, a consultant was present during induction of anaesthesia in those cases that had a cardiac arrest suggests efforts to match clinical staffing to patient and case complexity and risk. When a consultant was not present, another senior anaesthetist able to work autonomously was commonly involved.”
Outcomes after perioperative cardiac arrest
The second paper addresses the outcomes for patients who had a perioperative cardiac arrest.
Rates of successful resuscitation were notably higher for perioperative cardiac arrest than is achieved in cardiac arrests that take place out of hospital or in hospitals in other settings such as a hospital ward. Among 881 patients who had a cardiac arrest, 665 were successfully resuscitated and of 742 in whom their hospital outcome was known 384 (52%) had survived. The extent to which those who were discharged made a good functional recovery was reported in 284 survivors using a scale called the modified Rankin score (mRS), with 249 (88%) having a good functional score (0-3).
Multiple factors influenced the extent of success of resuscitation including patient age, pre-existing health, surgical specialty, the heart rhythm at cardiac arrest and duration of resuscitation. Survival to hospital discharge was worse in patients at the extremes of age with 40% of patients aged over 75 years and 45% of babies aged under 1 month old surviving. Hospital survival was also poorer when surgery was urgent, with 88% patients undergoing routine surgery and 37% of emergency cases surviving to discharge.
When death occurred, it was judged to be an unpreventable process in 31% of cases. The quality of care was generally good with care during and after cardiac arrest judged good in 80% and poor in fewer than 2%. However, elements of poor care before cardiac arrest were identified in 32% of cases and are a focus of opportunities to improve care.
Dr Soar says: “As patients undergoing surgery have become older and less healthy in the last decade, and surgical care has ever more to offer, it is inevitable that major complications, including cardiac arrest will occur. It is clear from this study that outcomes from perioperative cardiac arrests are substantially better than from other causes of cardiac arrest. Most patients survive the cardiac arrest and of those who go home the vast majority make a good recovery.”
Professor Cook adds: “It is notable that 80% of patients were successfully resuscitated and more than half managed to leave hospital. To put this in context, only 23% of patients who have a cardiac arrest elsewhere in hospital survive to leave and fewer than 10% of patients who have a cardiac arrest outside hospital are alive a month later. The higher survival rate is likely to be contributed to by being in a highly monitored environment and attended by a trained anaesthetist who can rapidly identify and respond to the causes of the cardiac arrest.”
Dr Armstrong concludes: “This study is important for clinicians and patients. For clinicians it provides a unique insight into the frequency, causes, contributing factors and outcomes of perioperative cardiac arrest. There are also areas identified for improvement. For patients, the project provides a rich resource of information which can be used to better inform them, so they can understand the risks and benefits of undergoing surgery and interventional procedures requiring anaesthesia.”
Dr Fiona Donald, President of the Royal College of Anaesthetists said: “For the first time, we have a clear, comprehensive and detailed picture of perioperative cardiac arrest in all NHS hospitals in the UK. Several million patients undergo surgery each year and this research shows they can have confidence that their risk of a cardiac arrest is very low. For the 1 in 3,000 patients who do experience it, the quality of care is high.
“NAP7 has huge potential to drive improvements in perioperative care. Alongside the wealth of in-depth data, the report also includes practical and accessible recommendations that will help us improve the prevention and treatment of perioperative cardiac arrest.”
Note that this paper includes the results from NAP7, which will be published in full on 17 November 2023. The Royal College of Anaesthetists National Audit Projects study rare but potentially serious complications related to anaesthesia. They are intended to examine, report on and drive improvements in practice and are delivered by the Royal College of Anaesthetists’ Centre for Research and Improvement. Each NAP focuses on a different topic important to patients and anaesthetists. NAP7 examines perioperative cardiac arrest.
NAP7 project link – https://www.nationalauditprojects.org.uk/NAP7-Home
RCoA NAP7 pages - https://www.rcoa.ac.uk/nap7-perioperative-cardiac-arrest
Notes
Cardiac arrest is when the heart stops beating – without cardiopulmonary resuscitation that includes chest compressions and, or defibrillation together with treating the cause of cardiac arrest, the patient will die.
Perioperative cardiac arrest occurs when cardiac arrest occurs during or soon after an operation. In this study it was defined as occurring during or within the first 24-hours after the procedure.
Modified Rankin Score (mRS) is a 6 point disability scale with possible scores ranging from 0 to 5. A separate category of 6 is usually added for patients who expire.
0 The patient has no residual symptoms.
1 The patient has no significant disability; able to carry out all pre-stroke activities.
2 The patient has slight disability; unable to carry out all pre-stroke activities but able to look after self without daily help.
3 The patient has moderate disability; requiring some external help but able to walk without the assistance of another individual.
4 The patient has moderately severe disability; unable to walk or attend to bodily functions without assistance of another individual.
5 The patient has severe disability; bedridden, incontinent, requires continuous care.
6 The patient has expired (during the hospital stay or after discharge from the hospital).
Rankin J (May 1957). "Cerebral vascular accidents in patients over the age of 60. II. Prognosis". Scott Med J. 2 (5): 200–15. doi:10.1177/003693305700200504. PMID 13432835. S2CID 29669359.
END
National analysis shows that 1 in 3000 patients experience cardiac arrest requiring resuscitation during anaesthesia
Study is the most in-depth into the nature, causes and consequence of perioperative cardiac arrest, perhaps the complication of surgery feared most by patients, anaesthetists and surgeons
2023-11-17
ELSE PRESS RELEASES FROM THIS DATE:
Cutting-edge research aims to curb fatalities caused by illicit drugs
2023-11-16
University of Technology Sydney (UTS) Centre for Forensic Science PhD candidate Harry Fursman is working on two fronts to prevent harm to people who use drugs: He is testing a new handheld device for rapidly and accurately identifying drug specimens and conducting ongoing chemical analysis of used syringes.
Drugs that are contaminated or substituted with an unexpected substance are a leading cause of death among people who use drugs. In Sydney last week one person died and two people were taken to hospital due to heroin overdoses, after using what ...
Paper offers perspective on future of brain-inspired AI as Python code library passes major milestone
2023-11-16
Four years ago, UC Santa Cruz’s Jason Eshraghian developed a Python library that combines neuroscience with artificial intelligence to create spiking neural networks, a machine learning method that takes inspiration from the brain’s ability to efficiently process data. Now, his open source code library, called “snnTorch,” has surpassed 100,000 downloads and is used in a wide variety of projects, from NASA satellite tracking efforts to semiconductor companies optimizing chips for AI.
A new paper published in the journal Proceedings of the IEEE documents the coding ...
Winners of Applied Microbiology International Horizon Awards are announced
2023-11-16
The winners of the Applied Microbiology International Horizon Awards were announced at the prestigious Environmental Microbiology lecture 2023, held at BMA House in London on November 16.
The prizes, awarded by Applied Microbiology International, celebrate the brightest minds in the field and promote the research, group, projects, products and individuals who continue to help shape the future of applied microbiology.
Dr Christopher Stewart of Newcastle University in the UK was named as this year’s winner of the WH Pierce Prize, which is presented to a scientist who has used microbiology to make a significant contribution to One Health advancements.
The primary ...
Highlights from the journal CHEST®, November 2023
2023-11-16
Glenview, Illinois – Published monthly, the journal CHEST® features peer-reviewed, cutting-edge original research in chest medicine: Pulmonary, critical care and sleep medicine and related disciplines. Journal topics include asthma, chest infections, COPD, critical care, diffuse lung disease, education and clinical practice, pulmonary vascular disease, sleep, thoracic oncology and the humanities.
The November issue of the CHEST journal contains 48 articles, including clinically relevant research, reviews, case series, commentary and more. Each month, the journal also offers complementary resources, including visual ...
Three-pronged approach discerns qualities of quantum spin liquids
2023-11-16
In 1973, physicist Phil Anderson hypothesized that the quantum spin liquid, or QSL, state existed on some triangular lattices, but he lacked the tools to delve deeper. Fifty years later, a team led by researchers associated with the Quantum Science Center headquartered at the Department of Energy’s Oak Ridge National Laboratory has confirmed the presence of QSL behavior in a new material with this structure, KYbSe2.
QSLs — an unusual state of matter controlled by interactions among entangled, or intrinsically linked, magnetic atoms called spins — excel at stabilizing quantum mechanical activity in KYbSe2 and other delafossites. These materials are prized for ...
Cancer therapy shows promise against tuberculosis
2023-11-16
A promising new cancer therapy also appears extremely potent against one of the world’s most devastating infectious diseases: tuberculosis (TB).
Scientists at Texas Biomedical Research Institute (Texas Biomed) found the therapy dramatically reduces TB growth, even for bacteria that are drug-resistant. The findings, reported in the journal Biomedicine & Pharmacotherapy, were made in novel cellular models featuring TB-infected human cells that can help accelerate screening of potential TB drugs and therapies like this one.
The therapy evaluated in this study combines two ...
Theoretical computer scientists awarded the John von Neumann Theory Prize
2023-11-16
Computer Science Professors Christos Papadimitriou and Mihalis Yannakakis received the John von Neumann Theory Prize for their research in computational complexity theory that explores the boundaries of efficiently solving decision and optimization problems crucial to operations research and management sciences.
The recipients were presented with the prize at the 2023 INFORMS Annual Meeting in October in Phoenix, AZ. The Institute for Operations Research and the Management Sciences (INFORMS) first awarded the prize in 1975 to honor a body of work that has proven its lasting value in operations research and management sciences. ...
Heat tolerant coral may trade fast growth for resilience
2023-11-16
Algae living within the soft tissue of coral supply much of the energy needed by their hosts, and some symbiotic algae help coral withstand warmer water better than others. In a recently published study led by the University of Hawai‘i at Mānoa, researchers found that there was a tradeoff for corals dominated by the thermally sensitive algae—they have higher growth, but only in cooler water.
“As the ocean continues to warm, understanding how symbionts and environmental factors affect coral growth and health will help predict reef futures and inform conservation interventions where coral stocks are selected ...
Genomic tug of war could boost cancer therapy
2023-11-16
Some patients with myelodysplastic syndromes, like acute myeloid leukemia, benefit from a chemotherapy drug called decitabine that stunts cancer growth. But many others are resistant to decatibine’s effects or become resistant over time. Wilmot Cancer Institute researchers have uncovered a “genomic tug of war” in animal studies that could influence how well certain patients—or certain cancers—respond to decitabine.
In a study published in the journal Development, ...
New research questions the nature and meaning of "psychic-channeling" experiences
2023-11-16
The question of disembodied consciousness or the afterlife has received much scientific scrutiny over the last several years. One line of research involves so-called "channelers" or mediums who claim to receive and communicate information that they believe comes from some other being or dimension of reality that differs from everyday reality. Now, an international team of scientists has critically examined these claims. New research published in the Journal of Scientific Exploration asked 15 pre-vetted channelers to access the same "nonphysical being or spirit" source and answer a structured set of 10 questions from the scientific team. The statistical ...
LAST 30 PRESS RELEASES:
Insulin resistance is linked to over 30 diseases – and to early death in women, study of people in the UK finds
Innovative semaglutide hydrogel could reduce diabetes shots to once a month
Weight loss could reduce the risk of severe infections in people with diabetes, UK research suggests
Long-term exposure to air pollution and a lack of green space increases the risk of hospitalization for respiratory conditions
Better cardiovascular health in early pregnancy may offset high genetic risk
Artificial intelligence method transforms gene mutation prediction in lung cancer: DeepGEM data releases at IASLC 2024 World Conference on Lung Cancer
Antibody–drug conjugate I-DXd shows clinically meaningful response in patients with extensive-stage small cell lung cancer
IASLC Global Survey on biomarker testing reveals progress and persistent barriers in lung cancer biomarker testing
Research shows pathway to developing predictive biomarkers for immune checkpoint inhibitors
Just how dangerous is Great Salt Lake dust? New research looks for clues
Maroulas appointed Associate Vice Chancellor, Director of AI Tennessee
New chickadee research finds cognitive skills impact lifespan
Cognitive behavioral therapy enhances brain circuits to relieve depression
Terasaki Institute awarded $2.3 Million grant from NIH for organ transplantation research using organs-on-a-chip technology
Atoms on the edge
Postdoc takes multipronged approach to muon detection
Mathematical proof: Five satellites needed for precise navigation
Scalable, multi-functional device lays groundwork for advanced quantum applications
Falling for financial scams? It may signal early Alzheimer’s disease
Integrating MRI and OCT for new insights into brain microstructure
Designing a normative neuroimaging library to support diagnosis of traumatic brain injury
Department of Energy announces $68 million in funding for artificial intelligence for scientific research
DOE, ORNL announce opportunity to define future of high-performance computing
Molecular simulations, supercomputing lead to energy-saving biomaterials breakthrough
Low-impact yoga and exercise found to help older women manage urinary incontinence
Genetic studies reveal new insights into cognitive impairment in schizophrenia
Researcher develops technology to provide cleaner energy and cleaner water
Expect the unexpected: nanoscale silver unveils intrinsic self-healing abilities
nTIDE September 2024 Jobs Report: Gains in employment for people with disabilities appear to level off after reducing gaps with non-disabled workers
Wiley enhances NMR Spectral Library Collection with extensive new databases
[Press-News.org] National analysis shows that 1 in 3000 patients experience cardiac arrest requiring resuscitation during anaesthesiaStudy is the most in-depth into the nature, causes and consequence of perioperative cardiac arrest, perhaps the complication of surgery feared most by patients, anaesthetists and surgeons