TY - JOUR
T1 - Intraoperative Cardiac Arrest during Adult Liver Transplantation
T2 - Incidence and Risk Factor Analysis from 7 Academic Centers in the United States
AU - Smith, Natalie K.
AU - Zerillo, Jeron
AU - Kim, Sang Jo
AU - Efune, Guy E.
AU - Wang, Cynthia
AU - Pai, Sher Lu
AU - Chadha, Ryan
AU - Kor, Todd M.
AU - Wetzel, David R.
AU - Hall, Michael A.
AU - Burton, Kristen K.
AU - Fukazawa, Kyota
AU - Hill, Bryan
AU - Spad, Mia Ashley
AU - Wax, David B.
AU - Lin, Hung Mo
AU - Liu, Xiaoyu
AU - Odeh, Jaffer
AU - Torsher, Laurence
AU - Kindscher, James D.
AU - Mandell, M. Susan
AU - Sakai, Tetsuro
AU - Demaria, Samuel
N1 - Publisher Copyright:
© 2020 International Anesthesia Research Society.
PY - 2021/1/1
Y1 - 2021/1/1
N2 - 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.
AB - 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.
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U2 - 10.1213/ANE.0000000000004734
DO - 10.1213/ANE.0000000000004734
M3 - Article
C2 - 32167977
AN - SCOPUS:85098331398
SN - 0003-2999
VL - 132
SP - 130
EP - 139
JO - Anesthesia and analgesia
JF - Anesthesia and analgesia
IS - 1
ER -