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OR, PACU best for surviving inpatient cardiac arrest

Saturday May 4, 2013
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Cardiac arrest that occurs in the OR or PACU is associated with improved survival compared with other locations in the hospital, according to a study.

The findings offer evidence that the presence of anesthesia providers in these locations may improve outcomes for certain patients, reported researchers with the University of Michigan.

Cardiac arrest is an uncommon complication during the perioperative period, with an estimated seven arrests per every 10,000 patients undergoing noncardiac surgery. Outcomes of cardiac arrest in the perioperative period have not been well-studied, according to background information for the study, which was published April 30 on the website of the journal Anesthesiology.

To better understand the management and outcomes of cardiac arrests during the perioperative period, researchers used the "Get With The Guidelines® — Resuscitation" registry, a national cardiopulmonary resuscitation registry supported by the American Heart Association. Researchers identified more than 2,500 instances of perioperative cardiac arrest from 234 hospitals.

Findings showed one in three patients survived cardiac arrest to hospital discharge. Among these patients, two of three had good brain function. In addition, survival was 25% to 65% higher if the cardiac arrest occurred in the OR or PACU than if it occurred in the ICU or general inpatient areas.

The researchers also found asystole was associated with improved survival in the OR and PACU compared with other hospital locations. They also found life-saving treatment was given much faster in these locations. Pulseless electrical activity was associated with worse survival to discharge in the ICU.

"The most surprising findings from our research were that very sick patients in the ICU and postoperative low-risk patients in general inpatient areas had the poorest outcomes," Satya Krishna Ramachandran, MD, FRCA, assistant professor in the Department of Anesthesiology at the University of Michigan, said in a news release.

"We found outcomes were best when cardiac arrest occurred during or immediately after surgery and anesthesia. This supports the view that the availability of anesthesia providers in the OR and PACU may contribute to better outcomes."

Read the study abstract: http://journals.lww.com/anesthesiology/Abstract/onlinefirst/Predictors_of_Survival_from_Perioperative.98419.aspx.


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