ABSTRACT
BACKGROUND: Intraoperative cardiac arrest (ICA) during liver transplantation (LT) is a rare surgical complication that results in devastating outcomes. Moreover, previous worldwide studies have found inconsistencies in the risk factors associated with ICA in LT. METHODS: This was a retrospective cohort study of adult patients who underwent LT between January and October 2021 at Siriraj Hospital, a tertiary care hospital. The incidence of ICA and outcomes of patients who experienced ICA were examined. Risk factors associated with ICA were investigated as a secondary objective. RESULTS: Among 342 patients, the incidence of ICA was 3.5% (95% CI 1.8%-6.1%). Of these, 33.3% died intraoperatively. Among patients with ICA, 41.7% died within 30 days, compared with only 7.6% in those without ICA (P = .002). Moreover, the in-hospital mortality rate of those with ICA was 58.3%, which was significantly higher than that of those without ICA (9.7%, P < .001). However, 41.7% of patients with ICA were discharged alive with long-term survival. Because ICA is a rare event, we found only 2 independent factors significantly associated with ICA. These factors include intraoperative temperature below 35°C, with an odds ratio (OR) of 6.07 (95% CI:1.32-27.88, P = .02) and elevated intraoperative serum potassium, with an OR of 4.57 (95% CI:2.15-9.67, P < .001). CONCLUSIONS: ICA is associated with high perioperative and in-hospital mortality. However, our findings suggest that with effective management of ICA, more than 40% of these patients could be discharged with excellent long-term outcomes. Hypothermia and hyperkalemia were independent risk factors significantly associated with ICA.
Subject(s)
Heart Arrest , Hospital Mortality , Intraoperative Complications , Liver Transplantation , Humans , Liver Transplantation/adverse effects , Liver Transplantation/mortality , Heart Arrest/epidemiology , Heart Arrest/etiology , Risk Factors , Male , Retrospective Studies , Female , Middle Aged , Incidence , Intraoperative Complications/epidemiology , Adult , Treatment Outcome , AgedABSTRACT
BACKGROUND: Pulmonary aspiration is a major complication in anesthesia, and various studies have shown that gastric sonography can reliably provide valuable information relative to both the qualitative and quantitative aspects of gastric content. This study aimed to determine the accuracy of ultrasound assessment of gastric content compared between two novice anesthesiologist gastric sonographers. METHODS: This prospective cohort study of two anesthesiologists learning to perform qualitative and quantitative ultrasound assessment of gastric content on healthy volunteers was conducted at Siriraj Hospital (Bangkok, Thailand). This trial was registered with ClinicalTrials.gov (reg. no. NCT04760106). RESULTS: Of the 50 enrolled participants, three were excluded due to study protocol violation. Each anesthesiologist performed a qualitative assessment on 47 participants for an overall total of 94 scans. There were 15 males and 32 females (age 42 ± 11.7 years, weight 61.2 ± 13.1 kg, height 160.7 ± 7.3 cm, and BMI 23.6 ± 4.3 kg/m2). The overall success rate for all gastric content categories was approximately 96%. From antral cross-sectional area measurement, as the ingested volume increased, there was a tendency toward increased deviation from the actual ingested volume. Interrater agreement between anesthesiologists was analyzed using intraclass correlation coefficients (ICCs). A larger fluid volume was found to be associated with a lower level of agreement between the two anesthesiologists. The ICCs were 0.706 (95% CI: -0.125 to 0.931), 0.669 (95% CI: -0.254 to 0.920), 0.362 (95% CI: -0.498 to 0.807) for the 100 ml, 200 ml, and 300 ml fluid volumes, respectively. The mean duration to perform an ultrasound examination for each gastric content category and for the entire examination did not differ significantly between anesthesiologists (p > 0.05). CONCLUSION: Our results indicate that qualitative ultrasound assessment of gastric content is highly accurate and can be easily learned. In contrast, quantification of gastric volume by novice gastric sonographers is more complex and requires more training. TRIAL REGISTRATION: ClinicalTrials.gov no. NCT04760106 Date registered on Feb 11, 2021. Prospectively registered.
