NAP7: Perioperative Cardiac Arrest

Question 1

Incidence of serious complications under general anaesthetic

Answer 1

1 in 18

Question 2

Incidence of cardiac arrest under general anaesthetic

Answer 2

1 in 3000. Vast majority non-shockable rhythm

Question 3

Incidence of survival of cardiac arrest under GA

Answer 3

75% survival. 88% of these survival to discharge from hospital.

Question 4

Most common cause of cardiac arrest under GA

Answer 4

• Major haemorrhage (17%)
• Bradyarrhythmia (9%)
• Cardiac Ischaemia (7%)

Question 5

RFx for serious complications under GA

Answer 5

• Very young
• Elderly
• Emergency surgery
• High ASA grade
• Male
• Increased frailty

Question 6

Surgical factors relating to high risk of cardiac arrest under GA

Answer 6

• Cardiac
• Orthopaedic
• Lower GI
• Vascular
• Interventional cardiology

Question 7

Recommendations from NAP 7

Answer 7

• Greater use of risk-stratifying tools pre-operatively e.g. SORT
• Better access to senior support for junior trainees working in remote areas
• Monitoring of patients on transfer eg from theatre to recovery
• Lower dose induction, slower inductions use of vasopressors in old frail patients, CV unstable pts, vascular surgery
• Induction of anaesthetic in theatre rather than anaesthetic room for identified high-risk cases
• Ensure access to cardiac arrest trolley easily available- especially in remote site working
• Formal support for staff following cardiac arrest