Incidence of intraoperative cardiac arrest in a tertiary cancer centre:A retrospective study

Abstract

Author(s): Sonali Opneja, Roopesh Sureshan*, Satheeshan Balasubramanian, Jashma C, Joona P, Namratha Divakaran, Rahul KV and Riyas M

Background: Cardiac arrest in the Operating Room (OR) and in the immediate postoperative period is a potentially catastrophic event that is almost always witnessed and is frequently anticipated.

Unlike cardiac arrest that occurs in nonhospital settings, staff members know the medical and surgical history of patients who suffer arrest in the perioperative period, allowing them to provide support that is outside the scope of traditional resuscitation algorithms, such as Advanced Cardiac Life Support (ACLS).

Aim: To know the incidence of Intra Operative Cardiac Arrest (IOCA) in patients undergoing oncosurgeries in Malabar cancer centre.

Cardiac arrest was defined as an event requiring cardiopulmonary resuscitation (CPR) with either closed-chest cardiac compression or open cardiac massage. The basis for judgment of cardiac arrest was whether the electrocardiogram (ECG) showed ventricular fibrillation, sudden disappearance of direct arterial blood pressure, and reduction of mean arterial pressure (MAP) to less than 20mmHg.Successful resuscitation of patients was defined as achieving a return of spontaneous circulation and MAP >60mmHg for more than 1 hour.

Settings and design: A retrospective analytic study was done in a tertiary cancer centre to know the incidence of intraoperative cardiac arrest from 1st January 2016 to 30th June 2022.All patients with records of IOCA during anaesthesia in the operating room were reviewed in this study during a period of 6 years between January 1, 2016 and June 30, 2022.

Results: Incidence rate for IOCA was calculated to be 0.13% (13 per 10,000 anaesthesia) for all the cases (0.47 for emergency and 0.83 for nonemergency cases). This is comparable to previously reported incidence of 2.99 to 40.4 per 10,000 anaesthesia. Values of heart rate and arterial blood pressures (systolic and diastolic) between emergency and nonemergency cases of IOCA (p<0.001 for heart rate; 0.023 for SBP; 0.045 for DBP) were significantly higher in emergency group for heart rate and lower for blood pressures. There was no significant difference in other clinical parameters.

Conclusion: Higher values of heart rate and lower values of systolic and diastolic blood pressure indicate their clear role in incidence of IOCA in oncopatients.

These clinical markers can be further evaluated for risk analysis and safer operative measures.

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