OBJECTIVETo evaluate the outcome of ST-elevation acute myocardial infarction (STEMI) patients complicated pre-hospital cardiac arrest underwent percutaneous coronary intervention (PCI).

METHODSFrom September 2004 to November 2008, 1446 consecutive patients with acute STEMI underwent PCI in our department. 49 out of 1446 patients complicated by pre-hospital cardiac arrest. Clinical outcome including total mortality, adverse cardiac events, stroke and bleeding events during the hospitalization period and within 1 year after discharge was compared between patients with or without pre-hospital cardiac arrest.

RESULTSPCI success rate was similar (85.7% vs. 88.8%, P = 0.497) while the incidence of in-hospital cardiogenic shock 22.4% vs. 3.0%, P < 0.001 and cardiac arrest (44.9% vs. 5.9%, P < 0.001) and in-hospital mortality (36.7% vs. 2.0%, P < 0.001) were significantly higher in patients with pre-hospital cardiac arrest than patients without pre-hospital cardiac arrest. Time from symptom onset to emergency treatment, asystole as initial rhythm, Glasgow coma scale (GCS ≤ 7) and cardiogenic shock on admission were independent risk factors of in-hospital death in patients with pre-hospital cardiac arrest. During follow up, incidences of overall mortality, re-infarction, revascularization and stroke were similar between the two groups.

CONCLUSIONSSTEMI patients with pre-hospital cardiac arrest undergoing emergency PCI are facing higher risk of cardiogenic shock and cardiac arrest and higher in-hospital mortality compared to those without pre-hospital cardiac arrest. However, the post-hospital discharge outcome was similar between the two groups.

Adult ; Aged ; Angioplasty, Balloon, Coronary ; Emergency Treatment ; Female ; Heart Arrest ; complications ; therapy ; Hospital Mortality ; Humans ; Male ; Middle Aged ; Myocardial Infarction ; complications ; mortality ; therapy ; Treatment Outcome

BACKGROUNDPatient safety has been gained much more attention in recent years. The authors reviewed patients who had cardiac arrest in the operating rooms undergoing noncardiac surgery between January 1989 and December 2001 at the University of Pittsburgh Medical Center, USA. The main objectives of the study were to determine the incidence of intraoperative cardiac arrest, to identify possible causes of cardiac arrest and to explore amenable modifications.

METHODSWith approval by the University of Pittsburgh Institutional Review Board, patients experienced cardiac arrest during surgery were retrieved from medical records, surgical operation and anesthesia records and pathological reports by searching the Medical Archival Retrieval System (MARS), a hospital electronic searching system. Cases of cardiac arrest were collected over a period of thirteen years from the Presbyterian University Hospital (PUH), USA.

RESULTSWe found 23 cases of intraoperative cardiac arrests occurred in 218 274 anesthesia cases (1.1 per 10 000). Fourteen patients (60.8%) died in the operating room, leading to a mortality rate from all causes of 0.64 per 10 000 anesthetics. Immediate overall survival rate after arrest was 39% (9/23). Half of the patients (12/23) were emergency cases with 41% survival rate (5/12). One fourth of the arrests were trauma patients (6/23). Most arrest patients (87%, 20/23) were American Society of Anesthesiologists Physical Status (ASA PS) IV and V, while only three patients were ASA PS-I, II and III, respectively. One case was attributable to an anesthesia-related cardiac arrest and recovered after successful resuscitation.

CONCLUSIONSMost intraoperative cardiac arrests were not due to anesthesia-related causes. Anesthesia-related cardiac arrests might have a higher survival rate when compared to other possible causes of cardiac arrest in the operating room.

Adult ; Aged ; Aged, 80 and over ; Anesthesia ; adverse effects ; mortality ; Female ; Heart Arrest ; etiology ; mortality ; Humans ; Intraoperative Complications ; mortality ; Male ; Middle Aged ; Retrospective Studies ; Young Adult

BACKGROUND: Recent interest in the use of normothermic blood cardioplegia is based on theoretical advantages over the traditional method of hypothermic myocardial protection. These reported advantages are a decrease in intraaortic balloon pump use, greater incidence of return to normal sinus rhythm, greater immediate cardiac outputs, and less time weaned from bypass after removal of the aortic cross-clamp. In addition to these advantages, normothermic blood cardioplegia offers the promise to resuscitate the ischemic myocardium and reduce the morbidity and mortality for patients with high-risk disease. This study was designed to compare the effects of cold crystalloid and normothermic blood cardioplegia on the postoperative recovery. METHODS: To evaluate the efficacy of cold versus normothermic cardioplegia, forty-four patients scheduled to undergoing valvular replacement surgery were selected to receive intermittent cold(4degrees C) crystalloid cardioplegia(n=22), group I or continuous normothermic(37degrees C) blood cardioplegia(n=22), group II. Cardiopulmonary bypass(CPB) and aortic cross-clamp(ACC) times were measured during the operation and patients were evaluated postoperatively for serum electrolytes, arterial blood gas analysis, blood pressure, heart rate, complications, ventilator periods and ICU stay. RESULTS: The ACC and CPB times were significantly longer in group II(165.9+/-44.8 min, 210.9+/-60.2 min) compared with group I(121.2+/-38.7 min, 149.7+/-38.1 min)(p<0.01). Group II patients had significantly higher serum potassium level(5.2+/-0.8 mEq/L) than group I(4.3+/-0.4 mEq/L) on the first postoperative day(p<0.01). ICU stay and ventilator period were not significantly different in two groups. There was no significant difference in postoperative complications and mortality rates between two groups. CONCLUSIONS: These results suggest that the continuous normothermic blood cardioplegia may be useful in myocardial protection during cardiac operation.
Blood Gas Analysis ; Blood Pressure ; Cardiac Output ; Electrolytes ; Heart Arrest, Induced* ; Heart Rate ; Heart* ; Humans ; Incidence ; Mortality ; Myocardium ; Postoperative Complications ; Potassium ; Thoracic Surgery* ; Ventilators, Mechanical

PURPOSE: The Physiological and Operative Severity Score for enUmeration of Mortality and morbidity (POSSUM) and its Portsmouth modification (P-POSSUM) are comprehensive assessment methods for evaluating patient and surgical factors widely used to predict 30-day mortality rates. In this retrospective study, we evaluated the usefulness of POSSUM and P-POSSUM in predicting 30-day mortality after intraoperative cardiac arrests in adult patients undergoing non-cardiac surgery. MATERIALS AND METHODS: Among 190486 patients who underwent anesthesia, 51 experienced intraoperative cardiac arrest as defined in our study protocol. Predicted mortality rates were calculated using POSSUM and P-POSSUM equations and were compared with actual outcomes using exponential and linear analyses. In addition, a receiver operating characteristic curve analysis was undertaken, and area-under-the-curve (AUC) values with confidence intervals (CIs) were calculated for POSSUM and P-POSSUM. RESULTS: Among the 51 patients with intraoperative cardiac arrest, 32 (62.7%) died within 30 days postoperatively. The overall predicted 30-day mortality rates using POSSUM and P-POSSUM were 65.5% and 57.5%, respectively. The observed-to-predicted (O:E) ratio for the POSSUM 30-day mortality was 1.07, with no significant difference between the observed and predicted values (chi2=4.794; p=0.779). P-POSSUM predicted mortality equally well, with an O:E ratio of 1.10 (chi2=8.905; p=0.350). AUC values (95% CI) were 0.771 (0.634-0.908) and 0.785 (0.651-0.918) for POSSUM and P-POSSUM, respectively. CONCLUSION: Both POSSUM and P-POSSUM performed well to predict overall 30-day mortality following intraoperative cardiac arrest in adults undergoing non-cardiac surgery at a university teaching hospital in Korea.
Adult ; Aged ; Female ; Heart Arrest/*complications/mortality ; Humans ; Incidence ; Intraoperative Complications/*mortality ; Male ; Middle Aged ; Morbidity ; Postoperative Period ; ROC Curve ; Republic of Korea/epidemiology ; Retrospective Studies ; Risk Assessment/*methods ; *Severity of Illness Index ; Surgical Procedures, Operative/*mortality

BACKGROUND: In this study, the role and the surgical outcome of the modified Blalock-Taussig shunt in the treatment of the infants with cyanotic complex congenital heart diseases were investigated. MATERIAL AND METHOD: Over the last 12 years, 105 modified BT shunts were performed in 100 infants. Postoperative course, shunt patency rate, complications, mortality and its risk factors were reviewed restrospectively. RESULT: The mean age at operation was 43.0 36.6 days. Sex ratio was 60:40(M:F). The postoperative oxygen saturations were lowest after mean duration of 11 hours after the shunt procedure. The operative mortality was 8%(8) with 3 late deaths. Causes of operative death included failure of maintenance of minimum oxygenation during the procedure(2), immediate postoperative shunt occlusion(2), respiratory failure(2), low cardiac output due to heart failure and pericardial effusion(2) and sepsis(2). Late deaths resulted from acute cardiac arrest during the follow up cardiac catheterization, hypoxic myocardial failure, and arrhythmia. Year of surgery, shunt size, age at operation, and complexity of the anomalies were not the risk factors for mortality. Six month shunt patency rate was 97% and overall patency rate was 96%. Postoperative complications comprised of shunt occlusion(6), phrenic nerve palsy(3), and wound infection(2). CONCLUSION: We demonstrated that modified Blalock-Taussig shunt was a useful tool to palliate the infants with complex cyanotic heart disease in whom early complete repair was not feasible with acceptable mortality and patency rate. An adequate postoperative management and a meticulous surgical technique may be key factors for the better results.
Arrhythmias, Cardiac ; Blalock-Taussig Procedure* ; Cardiac Catheterization ; Cardiac Catheters ; Cardiac Output, Low ; Follow-Up Studies ; Heart Arrest ; Heart Diseases ; Heart Failure ; Humans ; Infant ; Mortality ; Oxygen ; Phrenic Nerve ; Postoperative Complications ; Risk Factors ; Sex Ratio ; Wounds and Injuries