Cardiac arrest in obstetric patients receiving anaesthetic care: results from the 7th National Audit Project of the Royal College of Anaesthetists

Author:

Lucas D. N.1ORCID,Kursumovic E.23ORCID,Cook T. M.34ORCID,Kane A. D.25ORCID,Armstrong R. A.26ORCID,Plaat F.7,Soar J.8ORCID

Affiliation:

1. Department of Anaesthesia London North West University Healthcare NHS Trust UK

2. Royal College of Anaesthetists London UK

3. Department of Anaesthesia and Intensive Care Medicine Royal United Hospitals Bath NHS Foundation Trust Bath UK

4. University of Bristol Bristol UK

5. Department of Anaesthesia James Cook University Hospital South Tees NHS Foundation Trust Middlesbrough UK

6. Department of Anaesthesia Severn Deanery Bristol UK

7. Department of Anaesthesia Imperial College Healthcare NHS Trust London UK

8. Department of Anaesthesia and Intensive Care Medicine Southmead Hospital Bristol UK

Abstract

SummaryThe 7th National Audit Project (NAP7) of the Royal College of Anaesthetists studied peri‐operative cardiac arrest. Additional inclusion criteria for obstetric anaesthesia were: cardiac arrest associated with neuraxial block performed by an anaesthetist outside the operating theatre (labour epidural analgesia); and cardiac arrest associated with remifentanil patient‐controlled analgesia. There were 28 cases of cardiac arrest in obstetric patients, representing 3% of all cardiac arrests reported to NAP7, giving an incidence of 7.9 per 100,000 (95%CI 5.4–11.4 per 100,000). Obstetric patients were approximately four times less likely to have a cardiac arrest during anaesthesia care than patients having non‐obstetric surgery. The single leading cause of peri‐operative cardiac arrest in obstetric patients was haemorrhage, with underestimated severity and inadequate early resuscitation being contributory factors. When taken together, anaesthetic causes, high neuraxial block and bradyarrhythmia associated with spinal anaesthesia were the leading causes overall. Two patients had a cardiac arrest related to labour neuraxial analgesia. There were no cardiac arrests related to failed airway management or remifentanil patient‐controlled analgesia.

Publisher

Wiley

Subject

Anesthesiology and Pain Medicine

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