Critical incident technique analysis applied to perianesthetic cardiac arrests at a university teaching hospital

Objective To apply the critical incident technique (CIT) methodology to a series of perianesthetic cardiac arrest events at a university teaching hospital to describe the factors that contributed to cardiac arrest. Study design CIT qualitative analysis of a case series. Animals A group of 16 dogs and cats that suffered a perioperative cardiac arrest between November 2013 and November 2016. Methods If an arrest occurred, the event was discussed among the anesthesiologists. The discussion included a description of the case, a description of the sequence of events leading up to the arrest and a discussion of what could have been done to affect the outcome. A written description of the case and the event including animal signalment and a timeline of events was provided by the supervising anesthesiologist following discussion among the anesthesiologists. Only dogs or cats were included. After the data collection period, information from the medical record was collected. A qualitative document analysis was performed on the summaries provided about each case by the supervising anesthesiologist, the medical record and any supporting documents. Each case was then classified into one or more of the following: animal, human, equipment, drug and procedural factors for cardiac arrest. Results The most common factor was animal (n = 14), followed by human (n = 12), procedural (n = 4), drugs (n = 1) and equipment (n = 1). The majority (n = 11) of animals had multiple factors identified. Conclusions and clinical relevance Cardiac arrests during anesthesia at a referral teaching hospital were primarily a result of animal and human factors. Arrests because of procedural, drug and equipment factors were uncommon. Most animals experienced more than one factor and two animals arrested after a change in recumbency. Future work should focus on root cause analysis and interventions designed to minimize all factors, particularly human ones.