Intraoperative Cardiac Arrest During Adult Liver Transplantation: Incidence and Risk Factor Analysis From 7 Academic Centers in the United States

被引：27

作者：

Smith, Natalie K. ^{[1
]}

Zerillo, Jeron ^{[1
]}

Kim, Sang Jo ^{[2
]}

Efune, Guy E. ^{[3
]}

Wang, Cynthia ^{[4
]}

Pai, Sher-Lu ^{[5
]}

Chadha, Ryan ^{[5
]}

Kor, Todd M. ^{[6
]}

Wetzel, David R. ^{[6
]}

Hall, Michael A. ^{[7
]}

Burton, Kristen K. ^{[8
]}

Fukazawa, Kyota ^{[9
]}

Hill, Bryan ^{[10
]}

Spad, Mia-Ashley ^{[11
]}

Wax, David B. ^{[1
]}

Lin, Hung-Mo ^{[12
]}

Liu, Xiaoyu ^{[12
]}

Odeh, Jaffer ^{[3
]}

Torsher, Laurence ^{[6
]}

Kindscher, James D. ^{[13
]}

Mandell, M. Susan ^{[14
,15
]}

Sakai, Tetsuro ^{[16
]}

DeMaria, Samuel, Jr. ^{[1
]}

机构：

[1] Icahn Sch Med Mt Sinai, Dept Anesthesiol Perioperat & Pain Med, 1 Gustave L Levy Pl,POB 1010, New York, NY 10029 USA

[2] Hosp Special Surg, Dept Anesthesiol, 535 E 70th St, New York, NY 10021 USA

[3] Univ Texas Southwestern Med Ctr Dallas, Dept Anesthesiol & Pain Management, Dallas, TX 75390 USA

[4] Greater Los Angeles VA Healthcare Syst, Dept Anesthesiol, Los Angeles, CA USA

[5] Mayo Clin, Dept Anesthesiol & Perioperat Med, Jacksonville, FL 32224 USA

[6] Mayo Clin, Dept Anesthesiol & Perioperat Med, Rochester, MN USA

[7] Christiana Care Hlth Syst, Dept Anesthesiol, Newark, NJ USA

[8] Univ Penn, Perelman Sch Med, Dept Anesthesiol & Crit Care, Philadelphia, PA 19104 USA

[9] Univ Washington, Sch Med, Dept Anesthesiol & Pain Med, Seattle, WA USA

[10] Ohio State Univ, Dept Anesthesiol, Columbus, OH 43210 USA

[11] New York Med Coll, Valhalla, NY 10595 USA

[12] Icahn Sch Med Mt Sinai, Dept Populat Hlth Sci & Policy, New York, NY 10029 USA

[13] Univ Kansas, Med Ctr, Dept Anesthesiol, Kansas City, KS 66103 USA

[14] Univ Colorado Hosp, Dept Anesthesiol, Aurora, CO USA

[15] Univ Washington, Med Ctr, Ctr Perioperat & Pain Qual Safety & Outcomes PPQi, Seattle, WA 98195 USA

[16] Univ Pittsburgh, Med Ctr, Dept Anesthesiol & Perioperat Med, Pittsburgh, PA USA

来源：

ANESTHESIA AND ANALGESIA | 2021年 / 132卷 / 01期

关键词：

POSTREPERFUSION SYNDROME; MORTALITY; SURVIVAL; RETRANSPLANTATION; RECIPIENT; REPERFUSION; PREDICTORS; SURGERY; FRAILTY;

D O I：

10.1213/ANE.0000000000004734

中图分类号：

R614 [麻醉学];

学科分类号：

100217 ;

摘要：

Background: Intraoperative cardiac arrest (ICA) has a reported frequency of 1 in 10,000 anesthetics but has a much higher estimated incidence in orthotopic liver transplantation (OLT). Single-center studies of ICA in OLT are limited by small sample size that prohibits multivariable regression analysis of risks. METHODS: Utilizing data from 7 academic medical centers, we performed a retrospective, observational study of 5296 adult liver transplant recipients (18-80 years old) between 2000 and 2017 to identify the rate of ICA, associated risk factors, and outcomes. RESULTS: ICA occurred in 196 cases (3.7% 95% confidence interval [CI], 3.2-4.2) and mortality occurred in 62 patients (1.2%). The intraoperative mortality rate was 31.6% in patients who experienced ICA. In a multivariable generalized linear mixed model, ICA was associated with body mass index (BMI) <20 (odds ratio [OR]: 2.04, 95% CI, 1.05-3.98; P = .0386), BMI >= 40 (2.16 [1.12-4.19]; P = .022), Model for End-Stage Liver Disease (MELD) score: (MELD 30-39: 1.75 [1.09-2.79], P = .02; MELD >= 40: 2.73 [1.53-4.85], P = .001), postreperfusion syndrome (PRS) (3.83 [2.75-5.34], P < .001), living donors (2.13 [1.16-3.89], P = .014), and reoperation (1.87 [1.13-3.11], P = .015). Overall 30-day and 1-year mortality were 4.18% and 11.0%, respectively. After ICA, 30-day and 1-year mortality were 43.9% and 52%, respectively, compared to 2.6% and 9.3% without ICA. CONCLUSIONS: We established a 3.7% incidence of ICA and a 1.2% incidence of intraoperative mortality in liver transplantation and confirmed previously identified risk factors for ICA including BMI, MELD score, PRS, and reoperation and identified new risk factors including living donor and length of surgery in this multicenter retrospective cohort. ICA, while rare, is associated with high intraoperative mortality, and future research must focus on therapy to reduce the incidence of ICA.

引用

页码：130 / 139

页数：10

共 20 条

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