Postoperative Cardiac Arrest after Cardiac Surgery: Can we improve our Rescue Rate?

Objective Despite improvements in rescue strategies, postoperative cardiac arrest in adults undergoing cardiac surgery has not been examined in the contemporary era. This study assesses the incidence, outcomes, and predictors of survival in patients who suffered an in-hospital cardiac arrest after cardiac surgery. Methods Adult patients with cardiac arrest after open heart surgery from January 2012 to May 2019 at a single institution were studied. Patients were excluded if they underwent heart transplantation or LVAD implantation, experienced pre- or intra-operative cardiac arrest, received pre- or intra-operative temporary mechanical circulatory support, or were deemed do not resuscitate and/or care withdrawn prior to the arrest. Results Of 9,946 patients, 162 (1.6%) experienced a post-operative arrest with failure to rescue in 59 (36.4%) patients. The etiology of cardiac arrest was cardiovascular in 101 (62.3%), respiratory in 27 (16.7%), metabolic in 15 (9.3%), other in 12 (7.4%) and unknown in 7 (4.3%). Thirteen (8.0%) patients were placed on ECMO post-arrest with only 4 (30.8%) surviving to discharge. Patients were more likely to die in-hospital if they had post-operative, pre-arrest organ dysfunction (aOR 7.08, 95% CI: 2.92-17.16). Conclusions While the incidence of cardiac arrest was low, over one-third of patients failed to be rescued. Pre-arrest major organ dysfunction portended a significantly worse prognosis. Early recognition of a non-thriving patient and rapid escalation of specialized care may be critical in successful rescue from cardiac arrest and aborting catastrophic outcomes.