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CC BY-NC-ND 4.0 · J Neuroanaesth Crit Care 2018; 05(02): 87-93
DOI: 10.1055/s-0038-1666884
Original Article
Indian Society of Neuroanaesthesiology and Critical Care

Cardiac Arrest and Death in Neurosurgery: An Analysis of Perioperative Anesthetic Adverse Events in Thailand

Phuping Akavipat
1   Department of Anesthesiology, Prasat Neurological Institute, Bangkok, Thailand
,
Pimwan Sookplung
1   Department of Anesthesiology, Prasat Neurological Institute, Bangkok, Thailand
,
Thanatporn Boonsombat
1   Department of Anesthesiology, Prasat Neurological Institute, Bangkok, Thailand
,
Manee Raksakietisak
2   Department of Anesthesiology, Siriraj Hospital, Mahidol University, Bangkok, Thailand
,
Cataleya Tongrong
3   Department of Anesthesiology, Srinakarind Hospital, Khon Kaen University, Khon Kaen, Thailand
,
Surunchana Lerdsirisopon
4   Department of Anesthesiology, King Chulalongkorn Memorial Hospital, Chulalongkorn University, Bangkok, Thailand
,
Varinee Lekprasert
5   Department of Anesthesiology, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
,
Yodying Punjasawasdwong
6   Department of Anesthesiology, Maharaj Nakorn Chiangmai Hospital, Chiangmai University, Chiangmai, Thailand
,
Vichai Ittichaikulton
5   Department of Anesthesiology, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
› Institutsangaben Funding Support Royal College of Anesthesiologists of Thailand, Prasat Neurological Institute, Faculty of Medicine of Chiang Mai University, Chulalongkorn University, Khon Kaen University, Mahidol University (Siriraj Hospital and Ramathibodi Hospital), Prince of Songkla University, Health System Research Institute, and National Research Council of Thailand.
Weitere Informationen

Publikationsverlauf

Received: 30. April 2018

Accepted: 24. Mai 2018

Publikationsdatum:
26. Juni 2018 (online)

   Lizenzen und Reprints

Abstract

Background Complexities of pathological causes in cardiac arrest and death in neurosurgery require individualized management. To decrease the incidents, this study was performed to describe characteristics and factors reducing adverse outcomes together with potential corrective strategies of perioperative cardiac arrest and death in neurosurgical patients.

Methods An observational study was performed in 22 hospitals. Peer-reviewed consensus was formed using database from Perioperative Anesthetic Adverse Events in Thailand (PAAd Thai) study. The data contain demography, anesthetic, surgical details, opinions on contributing factors, and factors that minimized incident as well as suggested corrective strategies.

Results From 2,000 incidents, 64 (3%) cardiac arrest events were reported with a 50% chance of return of spontaneous circulation. The most common cardiac rhythm documented was asystole. Essentially, electrocardiography was the most frequent early detector. Surgical-related factors (81.3%), mostly intraoperative bleeding, played a major role in potential causes of arrest. In addition, anesthesia, patient conditions, and system-related factors were found in 65.6%, 57.8%, and 8.3% of the incidents, respectively. Moreover, the severity of the patients (73.3%) was considered to be the most common anesthesia-related risk factor. The prevention of an incident included rule enforcement for patient safety, mandatory knowledge, and also anesthesia personnel's skills development.

Conclusion The optimum fluid assessment and resuscitation, cerebral protection protocols, clinical awareness, and quality assurance together with human resource management are all essential to eliminate the catastrophic cardiac arrest and death in neurosurgery.

Keywords

complication - risk - cardiopulmonary resuscitation - neuroanesthesia - national audit
 

  • References

  • 1 Ellis SJ, Newland MC, Simonson JA. et al. Anesthesia-related cardiac arrest. Anesthesiology 2014; 120 (04) 829-838
    CrossrefPubMedGoogle Scholar
  • 2 Charuluxananan S, Punjasawadwong Y, Suraseranivongse S. et al. The Thai Anesthesia Incidents Study (THAI Study) of anesthetic outcomes: II. Anesthetic profiles and adverse events. J Med Assoc Thai 2005; 88 Suppl (07) S14-S29
    PubMedGoogle Scholar
  • 3 Charuluxananan S, Suraseranivongse S, Jantorn P. et al. Multicentered study of model of anesthesia related adverse events in Thailand by incident report (The Thai Anesthesia Incidents Monitoring Study): results. J Med Assoc Thai 2008; 91 (07) 1011-1019
    PubMedGoogle Scholar
  • 4 Charuluxananan S, Sriraj W, Punjasawadwong Y. et al. Perioperative and anesthetic adverse events in Thailand (PAAD THAI) incident reporting study: anesthetic profiles and outcomes. Asian Biomed 2017; 11 (01) 21-32
    PubMedGoogle Scholar
  • 5 McClain CD, Soriano SG. Anesthesia for intracranial surgery in infants and children. Curr Opin Anaesthesiol 2014; 27 (05) 465-469
    CrossrefPubMedGoogle Scholar
  • 6 Chowdhury T, Prabhakar H, Bithal PK, Schaller B, Dash HH. Immediate postoperative complications in transsphenoidal pituitary surgery: A prospective study. Saudi J Anaesth 2014; 8 (03) 335-341
    Google Scholar
  • 7 Punjasawadwong Y, Sriraj W, Charuluxananan S. et al. Perioperative and anesthetic adverse events in Thailand (PAAD THAI) incident reporting study: hospital characteristics and methods. Asian Biomed 2017; 11 (01) 33-39
    PubMedGoogle Scholar
  • 8 Brovman EY, Gabriel RA, Lekowski RW, Dutton RP, Urman RD. Rate of major anesthetic-related outcomes in the intraoperative and immediate postoperative period after cardiac surgery. J Cardiothorac Vasc Anesth 2016; 30 (02) 338-344
    CrossrefPubMedGoogle Scholar
  • 9 Zajac K, Zajac M. Perioperative mortality. Przegl Lek 2005; 62 (03) 173-180
    PubMedGoogle Scholar
  • 10 Watters DA, Babidge WJ, Kiermeier A, McCulloch GA, Maddern GJ. Perioperative mortality rates in australian public hospitals: the influence of age, gender and urgency. World J Surg 2016; 40 (11) 2591-2597
    CrossrefPubMedGoogle Scholar
  • 11 Zhou Y, Li W, Herath C. et al. Off-hour admission and mortality risk for 28 specific diseases: a systematic review and meta-analysis of 251 cohorts. J Am Heart Assoc 2016; 5 (03) e003102
    CrossrefPubMedGoogle Scholar
  • 12 Akavipat P, Ittichaikulthol W, Tuchinda L, Sothikarnmanee T, Klanarong S, Pranootnarabhal T. The Thai Anesthesia Incidents (THAI Study) of anesthetic risk factors related to perioperative death and perioperative cardiovascular complications in intracranial surgery. J Med Assoc Thai 2007; 90 (08) 1565-1572
    PubMedGoogle Scholar
  • 13 Do DH, Hayase J, Tiecher RD, Bai Y, Hu X, Boyle NG. ECG changes on continuous telemetry preceding in-hospital cardiac arrests. J Electrocardiol 2015; 48 (06) 1062-1068
    CrossrefPubMedGoogle Scholar
  • 14 Biering-Sørensen F, Biering-Sørensen T, Liu N, Malmqvist L, Wecht JM, Krassioukov A. Alterations in cardiac autonomic control in spinal cord injury. Auton Neurosci 2018; 209: 4-18
    CrossrefPubMedGoogle Scholar
  • 15 Bein B, Seewald S, Gräsner JT. How to avoid catastrophic events on the ward. Best Pract Res Clin Anaesthesiol 2016; 30 (02) 237-245
    CrossrefPubMedGoogle Scholar
  • 16 Chang CH. Medical simulation is needed in anesthesia training to achieve patient's safety. Korean J Anesthesiol 2013; 64 (03) 204-211
    CrossrefPubMedGoogle Scholar
  • 17 Lee JH, Kim EK, Song IK. et al. Critical incidents, including cardiac arrest, associated with pediatric anesthesia at a tertiary teaching children's hospital. Paediatr Anaesth 2016; 26 (04) 409-417
    CrossrefPubMedGoogle Scholar
  • 18 Amnuaypattanapon K, Udomsubpayakul U. Evaluation of related factors and the outcome in cardiac arrest resuscitation at Thammasat Emergency Department. J Med Assoc Thai 2010; 93 Suppl (07) S26-S34
    PubMedGoogle Scholar
  • 19 Fei Y, Wang L, Zhong T. Factor analysis for the prognosis of perioperative cardiopulmonary resuscitation [in Chinese]. Zhonghua Yi Xue Za Zhi 2014; 94 (01) 18-21
    PubMedGoogle Scholar
  • 20 Yi HJ, Kim YS, Ko Y, Oh SJ, Kim KM, Oh SH. Factors associated with survival and neurological outcome after cardiopulmonary resuscitation of neurosurgical intensive care unit patients. Neurosurgery 2006; 59 (04) 838-845 discussion 845–846
    CrossrefPubMedGoogle Scholar
  • 21 Germans MR, Boogaarts HD, Macdonald RL. Neuroprotection in critical care neurology. Semin Neurol 2016; 36 (06) 642-648
    Artikel in Thieme ConnectPubMedGoogle Scholar
  • 22 Cleland S, Corredor C, Ye JJ, Srinivas C, McCluskey SA. Massive haemorrhage in liver transplantation: consequences, prediction and management. World J Transplant 2016; 6 (02) 291-305
    PubMedGoogle Scholar
  • 23 Tran A, Matar M, Steyerberg EW, Lampron J, Taljaard M, Vaillancourt C. Early identification of patients requiring massive transfusion, embolization, or hemostatic surgery for traumatic hemorrhage: a systematic review protocol. Syst Rev 2017; 6 (01) 80
    CrossrefPubMedGoogle Scholar
  • 24 Wijdicks EF, Sheth KN, Carter BS. et al; American Heart Association Stroke Council. Recommendations for the management of cerebral and cerebellar infarction with swelling: a statement for healthcare professionals from the American Heart Association/American Stroke Association. Stroke 2014; 45 (04) 1222-1238
    CrossrefPubMedGoogle Scholar
  • 25 Treml AB, Gorlin JB, Dutton RP, Scavone BM. Massive transfusion protocols: a survey of Academic Medical Centers in the United States. Anesth Analg 2017; 124 (01) 277-281
    CrossrefPubMedGoogle Scholar
  • 26 Teixeira PG, Inaba K, Hadjizacharia P. et al. Preventable or potentially preventable mortality at a mature trauma center. J Trauma 2007; 63 (06) 1338-1346 discussion 1346–1347
    CrossrefPubMedGoogle Scholar
  • 27 Haugen AS, Søfteland E, Almeland SK. et al. Effect of the World Health Organization checklist on patient outcomes: a stepped wedge cluster randomized controlled trial. Ann Surg 2015; 261 (05) 821-828
    CrossrefPubMedGoogle Scholar
  • 28 Ibrahim GM, Morgan BR, Macdonald RL. Patient phenotypes associated with outcomes after aneurysmal subarachnoid hemorrhage: a principal component analysis. Stroke 2014; 45 (03) 670-676
    CrossrefPubMedGoogle Scholar
  • 29 Garden AL, Le Fevre DM, Waddington HL, Weller JM. Debriefing after simulation-based non-technical skill training in healthcare: a systematic review of effective practice. Anaesth Intensive Care 2015; 43 (03) 300-308
    CrossrefPubMedGoogle Scholar
  • 30 Matveevskii A, Moore DL, Samuels PJ. Competency and professionalism in medicine. Clin Teach 2012; 9 (02) 75-79
    CrossrefPubMedGoogle Scholar