Advanced life support interventions during intra-operative cardiac arrest among adults as reported to the 7th National Audit Project of the Royal College of Anaesthetists

Jerry P Nolan; Richard A Armstrong; Andrew D Kane; Emira Kursumovic; Matthew T Davies; Iain K Moppett; Tim M Cook; Jasmeet Soar; NAP7 Collaborators

doi:10.1111/anae.16310

Advanced life support interventions during intra-operative cardiac arrest among adults as reported to the 7th National Audit Project of the Royal College of Anaesthetists

Anaesthesia. 2024 May 10. doi: 10.1111/anae.16310. Online ahead of print.

Authors

Jerry P Nolan^{1

2}, Richard A Armstrong^{3

4}, Andrew D Kane^{3

5}, Emira Kursumovic^{2

3}, Matthew T Davies⁶, Iain K Moppett^{3

7}, Tim M Cook², Jasmeet Soar⁸; NAP7 Collaborators

Affiliations

¹ Department of Resuscitation Medicine, Warwick Clinical Trials Unit, University of Warwick, Warwick, UK.
² Department of Anaesthesia and Intensive Care Medicine, Royal United Hospitals Bath NHS Foundation Trust, Combe Park, Bath, BA1 3NG, UK.
³ Health Services Research Centre, Royal College of Anaesthetists, London, UK.
⁴ Department of Anaesthesia, Severn Deanery, Bristol, UK.
⁵ Department of Anaesthesia, James Cook University Hospital, South Tees NHS Foundation Trust, Middlesbrough, UK.
⁶ Department of Anaesthesia and Intensive Care Medicine, Royal United Hospitals Bath NHS Foundation Trust, Combe Park, Bath, BA1 3NG, United Kingdom.
⁷ Department of Critical Care and Anaesthesia, North West Anglia NHS Trust, UK.
⁸ Department of Anaesthesia and Peri-operative Medicine, University of Nottingham, Nottingham, UK.

PMID: 38733063
DOI: 10.1111/anae.16310

Abstract

Background: Few existing resuscitation guidelines include specific reference to intra-operative cardiac arrest, but its optimal treatment is likely to require some adaptation of standard protocols.

Methods: We analysed data from the 7th National Audit Project of the Royal College of Anaesthetists to determine the incidence and outcome from intra-operative cardiac arrest and to summarise the advanced life support interventions reported as being used by anaesthetists.

Results: In the baseline survey, > 50% of anaesthetists responded that they would start chest compressions when the non-invasive systolic pressure was < 40-50 mmHg. Of the 881 registry patients, 548 were adult patients (aged > 18 years) having non-obstetric procedures under the care of an anaesthetist, and who had arrested during anaesthesia (from induction to emergence). Sustained return of spontaneous circulation was achieved in 425 (78%) patients and 338 (62%) were alive at the time of reporting. In the 365 patients with pulseless electrical activity or bradycardia, adrenaline was given as a 1 mg bolus in 237 (65%). A precordial thump was used in 14 (3%) patients, and although this was associated with return of spontaneous circulation at the next rhythm check in almost three-quarters of patients, in only one of these was the initial rhythm shockable. Calcium (gluconate or chloride) and 8.4% sodium bicarbonate were given to 51 (9%) and 25 (5%) patients, but there were specific indications for these treatments in less than half of the patients. A thrombolytic drug was given to 5 (1%) patients, and extracorporeal cardiopulmonary resuscitation was used in 9 (2%) of which eight occurred during cardiac procedures.

Conclusions: The specific characteristics of intra-operative cardiac arrest imply that its optimal treatment requires modifications to standard advanced life support guidelines.

Keywords: NAP7; adrenaline; advanced life support; intra‐operative cardiac arrest.

Grants and funding

Royal College of Anaesthetists