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Fatal and non fatal cardiac arrests related to anesthesia

Philippe Biboulet, MD^*, Pierre Aubas, MD, Jacques Dubourdieu, MD^*, Josh Rubenovitch, MD BSc^*, Xavier Capdevila, MD PhD^* and Françoise d'Athis, MD^*

^* From the Department of Anesthesiology and
Critical Care "A" and Department of Medical Information, Lapeyronie University Hospital, Montpellier, France.

Address correspondence to: Dr. Ph. Biboulet, Département d'Anesthésie Réanimation A, Hôpital Lapeyronie, 34295 Montpellier cedex, France. Phone: 33-4-6733-8256; Fax: 33-4-6733-7960; E-mail: p-biboulet{at}chu-montpellier.fr

Purpose: The aim of this study was to assess the incidence and causes of cardiac arrests related to anesthesia.

Methods: All patients undergoing anesthesia over a six year period were included in a prospective study. The cardiac arrests encountered during anesthesia and the first twelve postoperative hours in the PACU or ICU were analysed. For each arrest, partially or totally related to anesthesia, the sequence of events leading to the accident was evaluated.

Results: Eleven cardiac arrests related to anesthesia were identified among the 101,769 anesthetic procedures (frequency : 1.1/10,000 [0.44-1.72]). Mortality related to anesthesia was 0.6/10,000 [0.12-1.06]. Age over 84 yr and an ASA physical status > 2 were found to be risk factors of cardiac arrest related to anesthesia. The main causes of anesthesia related cardiac arrest were anesthetic overdose (four cases), hypovolemia (two cases) and hypoxemia due to difficult tracheal intubation (two cases). No cardiac arrests due to alveolar hypoventilation were noted during the postoperative periods in either PACU or ICU. At least one human error was noted in ten of the eleven cardiac arrests cases, due to poor preoperative evaluation in seven. All cardiac arrests totally related to anesthesia were classified as avoidable.

Conclusion: Efforts must be directed towards improving preoperative patient evaluation. Anesthetic induction doses should be titrated in all ASA 3 and 4 patients. The prediction of difficult tracheal intubation, and if required, the use of awake tracheal intubation techniques, should remain a priority when performing general anesthesia.

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