Resuscitation 84 (2013) 635–638 Contents lists available at SciVerse ScienceDirect Resuscitation jo u rn al hom epage : www.elsevier.com/locate/resuscitation Clinical paper Outcomes of patients with trauma and intraoperative cardiac arrest  Flavia O. Toledo a , Maria M. Gonzalez b,∗ , Ilana Sebbag a , Rolison G.B. Lelis a , Gustavo F. Aranha a , Sergio Timerman b , Maria J.C. Carmona a a Discipline of Anesthesiology, Clinical Hospital, University of Sao Paulo Medical School, 255 Doctor Eneas de Carvalho Aguiar Avenue, Cerqueira Cesar, Sao Paulo, SP, Brazil b Heart Institute (InCor), University of Sao Paulo Medical School, 44 Doctor Eneas de Carvalho Aguiar Avenue, Cerqueira Cesar, Sao Paulo, SP, Brazil a r t i c l e i n f o Article history: Received 31 January 2012 Received in revised form 5 September 2012 Accepted 10 September 2012 Keywords: Cardiac arrest Intraoperative Cardiopulmonary resuscitation Survival Trauma a b s t r a c t Background: Although the occurrence of intraoperative cardiac arrest is rare, it is a severe adverse event with a high mortality rate. Trauma patients have additional causes for intraoperative arrest, and we hypothesised that the survival of trauma patients who experienced intraoperative cardiac arrest would be worse than nontrauma patients who experienced intraoperative cardiac arrest. Objectives: The aim of the present study was to compare the outcomes of trauma and nontrauma patients after intraoperative cardiac arrest. Methods: In a tertiary university hospital and trauma centre, the intraoperative cardiac arrest cases were evaluated from January 2007 to December 2009, excluding patients submitted to cardiac surgery. Data were prospectively collected using the Utstein-style. Outcomes among the patients with trauma were compared to the patients without trauma. Results: We collected data from 81 consecutive intraoperative cardiac arrest cases: 32 with trauma and 49 without trauma. Patients in the trauma group were younger than the patients in the nontrauma group (44 ± 23 vs. 63 ± 17, p < 0.001). Hypovolaemia (63% vs. 35%, p = 0.022) and metabolic/hydroelectrolytic disturbances (41% vs. 2%, p < 0.001) were more likely to cause the cardiac arrest in the trauma group. The first documented arrest rhythm did not differ between the groups, and pulseless electrical activity was the most prevalent rhythm (66% vs. 53%, p = 0.698). The return of spontaneous circulation (47% vs. 63%, p = 0.146) and survival to discharge with favourable neurological outcome (16% vs. 14%, p = 0.869) did not differ between the two groups. Conclusions: The outcomes did not differ between patients with trauma and nontrauma intraoperative cardiac arrest. © 2012 Elsevier Ireland Ltd. All rights reserved. 1. Introduction Despite significant advances in intraoperative physiologic mon- itoring and surgical anaesthetic techniques, perioperative cardiac arrest still represents the most catastrophic complication dur- ing surgery and compromises the postoperative recovery of many patients. The mechanisms related to intraoperative cardiac arrest differ from those responsible for out-of-hospital events. Hypo- volaemia due to bleeding is the most frequent cause of cardiac arrest reported during surgery. 1,2 The reported incidence of intra- operative cardiac arrest varies widely from 3 to 39 cases in 10,000 operations. 1,3 Because of the increasing age of patients, preexisting diseases or trauma, and new surgical interventions, cardiac arrests remain a serious concern. 3,4  A Spanish translated version of the summary of this article appears as Appendix in the final online version at http://dx.doi.org/10.1016/j.resuscitation.2012.09.019. ∗ Corresponding author. Tel.: +55 11 2661 7003; fax: +55 11 2661 7002. E-mail address: maria.gonzalez@incor.usp.br (M.M. Gonzalez). Trauma is a worldwide problem with severe and wide-ranging consequences for individuals and society as a whole. Trauma affects all nations and people from all walks of life and remains the leading cause of death in people under the age of 40 years. 5,6 In this context, trauma patients may present cardiac arrest due to an association of complex lesions and/or various organic disorders, increasing the mortality rate. 5 The occurrence of cardiac arrest during surgery in trauma patients is not a rare event because of the severity of the patients’ conditions, but there are few reports and studies that report car- diac arrest associated with trauma. 7 The causes of arrest in victims of trauma during surgery are numerous, and common examples include the severity of the patients’ injuries, hypovolaemia associ- ated with bleeding, and electrolyte disturbances. 6,7 In the present study, we hypothesised that the survival of patients with trauma and subsequent intraoperative cardiac arrest (the trauma group) would be less likely to attain a return of spon- taneous circulation (ROSC) and survive to hospital discharge with a favourable neurological outcome compared with nontrauma intra- operative cardiac arrest patients (the nontrauma group). 0300-9572/$ – see front matter © 2012 Elsevier Ireland Ltd. All rights reserved. http://dx.doi.org/10.1016/j.resuscitation.2012.09.019