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Summary: The 7th National Audit Project of the Royal College of Anaesthetists studied peri‐operative cardiac arrest. An activity survey estimated UK paediatric anaesthesia annual caseload as 390,000 cases, 14% of the UK total. Paediatric peri‐operative cardiac arrests accounted for 104 (12%) reports giving an incidence of 3 in 10,000 anaesthetics (95%CI 2.2–3.3 per 10,000). The incidence of peri‐operative cardiac arrest was highest in neonates (27, 26%), infants (36, 35%) and children with congenital heart disease (44, 42%) and most reports were from tertiary centres (88, 85%). Frequent precipitants of cardiac arrest in non‐cardiac surgery included: severe hypoxaemia (20, 22%); bradycardia (10, 11%); and major haemorrhage (9, 8%). Cardiac tamponade and isolated severe hypotension featured prominently as causes of cardiac arrest in children undergoing cardiac surgery or cardiological procedures. Themes identified at review included: inappropriate choices and doses of anaesthetic drugs for intravenous induction; bradycardias associated with high concentrations of volatile anaesthetic agent or airway manipulation; use of atropine in the place of adrenaline; and inadequate monitoring. Overall quality of care was judged by the panel to be good in 64 (62%) cases, which compares favourably with adults (371, 52%). The study provides insight into paediatric anaesthetic practice, complications and peri‐operative cardiac arrest. [ABSTRACT FROM AUTHOR]

Summary: Appendicectomy is a common procedure in children with a low risk of mortality, however, complication rates and risk factors are largely unknown. This study aimed to characterise the incidence and epidemiology of postoperative complications in children undergoing appendicectomy in the UK. This multicentre prospective observational cohort study, which included children aged 1–16 y who underwent surgery for suspected appendicitis, was conducted between November 2019 and January 2022. The primary outcome was 30‐day postoperative morbidity. Data collected included: patient characteristics; comorbidities; and physiological status. Multivariable regression analysis was used to identify independent risk factors for poor outcomes. Data from 2799 children recruited from 80 hospitals were analysed, of which 185 (7%) developed postoperative complications. Children from black and 'other' minority ethnic groups were at significantly higher risk of poor outcomes: OR (95%CI) 4.13 (1.87–9.08), p < 0.001 and 2.08 (1.12–3.87), p = 0.021, respectively. This finding was independent of socio‐economic status and type of appendicitis found on histology. Other risk factors for complications included: ASA physical status ≥ 3 (OR (95%CI) 4.05 (1.70–9.67), p = 0.002); raised C‐reactive protein (OR 95%CI 1.01 (1.00–1.01), p < 0.001); pyrexia (OR (95%CI) 1.77(1.20–2.63), p = 0.004); and peri‐operative oxygen supplementation (OR (95%CI) 4.20 (1.44–12.24), p = 0.009). In the UK NHS, which is a universally accessible healthcare system, ethnicity, but not socio‐economic status, was associated with an increased risk of postoperative complications in children having surgery for acute appendicitis. Further evaluations and interventions are required to address this health inequality in keeping with NHS and international priorities. [ABSTRACT FROM AUTHOR]

Summary: The 7th National Audit Project of the Royal College of Anaesthetists studied peri‐operative cardiac arrest in the UK. We report the results of the vascular surgery cohort from the 12‐month case registry, from 16 June 2021 to 15 June 2022. Anaesthesia for vascular surgery accounted for 2% of UK anaesthetic caseload and included 69 (8%) reported peri‐operative cardiac arrests, giving an estimated incidence of 1 in 670 vascular anaesthetics (95%CI 1 in 520–830). The high‐risk nature of the vascular population is reflected by the proportion of patients who were ASA physical status 4 (30, 43%) or 5 (19, 28%); the age of patients (80% aged > 65 y); and that most cardiac arrests (57, 83%) occurred during non‐elective surgery. The most common vascular surgical procedures among patients who had a cardiac arrest were: aortic surgery (38, 55%); lower‐limb revascularisation (13, 19%); and lower‐limb amputation (8, 12%). Among patients having vascular surgery and who had a cardiac arrest, 28 (41%) presented with a ruptured abdominal aortic aneurysm. There were 48 (70%) patients who had died at the time of reporting to NAP7 and 11 (16%) were still in hospital, signifying poorer outcomes compared with the non‐vascular surgical cohort. The most common cause of cardiac arrest was major haemorrhage (39, 57%), but multiple other causes reflected the critical illness of the patients and the complexity of surgery. This is the first analysis of the incidence, management and outcomes of peri‐operative cardiac arrest during vascular anaesthesia in the UK. [ABSTRACT FROM AUTHOR]

Summary: Peri‐operative anaphylaxis is a rare but potentially catastrophic event which must be considered whenever unexpected and significant cardiovascular or respiratory compromise occurs during anaesthesia. The Resuscitation Council UK algorithm for peri‐operative anaphylaxis highlights the importance of early intravenous adrenaline and fluid resuscitation and provides guidance on the treatment of refractory anaphylaxis and immediate follow‐up. This algorithm is endorsed by the Royal College of Anaesthetists, Association of Anaesthetists, British Society of Allergy and Clinical Immunology and Clinical Immunology Professional Network of the British Society for Immunology. This document was produced by the Perioperative Allergy Network steering committee in collaboration with the Resuscitation Council UK. [ABSTRACT FROM AUTHOR]

Summary: Complications are common following major surgery and are associated with increased use of healthcare resources, disability and mortality. Continued reliance on mortality estimates risks harming patients and health systems, but existing tools for predicting complications are unwieldy and inaccurate. We aimed to systematically construct an accurate pre‐operative model for predicting major postoperative complications; compare its performance against existing tools; and identify sources of inaccuracy in predictive models more generally. Complete patient records from the UK Peri‐operative Quality Improvement Programme dataset were analysed. Major complications were defined as Clavien–Dindo grade ≥ 2 for novel models. In a 75% train:25% test split cohort, we developed a pipeline of increasingly complex models, prioritising pre‐operative predictors using Least Absolute Shrinkage and Selection Operators (LASSO). We defined the best model in the training cohort by the lowest Akaike's information criterion, balancing accuracy and simplicity. Of the 24,983 included cases, 6389 (25.6%) patients developed major complications. Potentially modifiable risk factors (pain, reduced mobility and smoking) were retained. The best‐performing model was highly complex, specifying individual hospital complication rates and 11 patient covariates. This novel model showed substantially superior performance over generic and specific prediction models and scores. We have developed a novel complications model with good internal accuracy, re‐prioritised predictor variables and identified hospital‐level variation as an important, but overlooked, source of inaccuracy in existing tools. The complexity of the best‐performing model does, however, highlight the need for a step‐change in clinical risk prediction to automate the delivery of informative risk estimates in clinical systems. [ABSTRACT FROM AUTHOR]

Summary: Each year approximately one million people suffer spinal cord injury, which has significant physical, psychosocial and economic impacts on patients and their families. Spinal cord rehabilitation centres are a well‐established part of the care pathway for patients with spinal cord injury and facilitate improvements in functional independence and reductions in healthcare costs. Within the UK, however, there are a limited number of spinal cord injury centres, which delays admission. Patients and their families often perceive that they are not receiving specialist care while being treated in non‐specialist units. This review aimed to provide clinicians who work in non‐specialist spinal injury centres with a summary of contemporary studies relevant to the critical care management of patients with cervical spinal cord injury. We undertook a targeted literature review including guidelines, systematic reviews, meta‐analyses, clinical trials and randomised controlled trials published in English between 1 June 2017 and 1 June 2023. Studies involving key clinical management strategies published before this time, but which have not been updated or repeated, were also included. We then summarised the key management themes: acute critical care management approaches (including ventilation strategies, blood pressure management and tracheostomy insertion); respiratory weaning techniques; management of pain and autonomic dysreflexia; and rehabilitation. [ABSTRACT FROM AUTHOR]

This article discusses the findings of the 7th National Audit Project (NAP7) of the Royal College of Anaesthetists, which focuses on the organization and preparedness for peri-operative cardiac arrest in UK hospitals. The study found that while peri-operative cardiac arrests are relatively rare, they are significant for healthcare providers, with nearly half of respondents having managed at least one in the past two years. The study also highlighted areas for improvement in organizational preparedness, such as the availability of emergency equipment and the provision of training. The article emphasizes the importance of addressing these challenges to ensure optimal patient care. [Extracted from the article]

The article discusses the occurrence of peri-operative cardiac arrests, which are critical life-threatening events that can happen during or after a surgical procedure. The study, called the 7th National Audit Program of the Royal College of Anaesthetists (NAP7), provides insights into the epidemiology, causes, management, and outcomes of peri-operative cardiac arrests in the UK. The incidence of cardiac arrest in the study was found to be lower compared to previous data, suggesting a potential decrease in frequency. However, patient factors, resources, and practitioner skills all contribute to the risk of cardiac arrest. The study emphasizes the importance of timely interventions, adequate patient monitoring, and skilled clinical care to prevent and mitigate morbidity associated with peri-operative cardiac arrests. [Extracted from the article]

Summary: The 7th National Audit Project of the Royal College of Anaesthetists studied peri‐operative cardiac arrest in the UK, a topic of importance to patients, anaesthetists and surgeons. We report the results of the 12‐month registry phase, from 16 June 2021 to 15 June 2022, focusing on management and outcomes. Among 881 cases of peri‐operative cardiac arrest, the initial rhythm was non‐shockable in 723 (82%) cases, most commonly pulseless electrical activity. There were 665 (75%) patients who survived the initial event and 384 (52%) who survived to hospital discharge. A favourable functional outcome (based on modified Rankin Scale score) was reported for 249 (88%) survivors. Outcomes varied according to arrest rhythm. The highest rates of survival were seen for bradycardic cardiac arrests with 111 (86%) patients surviving the initial event and 77 (60%) patients surviving the hospital episode. The lowest survival rates were seen for patients with pulseless electrical activity, with 312 (68%) surviving the initial episode and 156 (34%) surviving to hospital discharge. Survival to hospital discharge was worse in patients at the extremes of age with 76 (40%) patients aged > 75 y and 9 (45%) neonates surviving. Hospital survival was also associated with surgical priority, with 175 (88%) elective patients and 176 (37%) non‐elective patients surviving to discharge. Outcomes varied with the cause of cardiac arrest, with lower initial survival rates for pulmonary embolism (5, 31%) and bone cement implantation syndrome (9, 45%), and hospital survival of < 25% for pulmonary embolism (0), septic shock (13, 24%) and significant hyperkalaemia (1, 20%). Overall care was rated good in 464 (53%) cases, and 18 (2%) cases had overall care rated as poor. Poor care elements were present in a further 245 (28%) cases. Care before cardiac arrest was the phase most frequently rated as poor (92, 11%) with elements of poor care identified in another 186 (21%) cases. These results describe the management and outcomes of peri‐operative cardiac arrest in UK practice for the first time. [ABSTRACT FROM AUTHOR]

This article discusses a study that examined the prevalence of tobacco smoking among patients undergoing elective vascular surgery in the UK. The study found that 25.4% of patients were actively smoking at the time of surgery, while 57.6% were former smokers and 17.0% had never smoked. The highest smoking rates were observed in patients undergoing lower limb bypass, carotid surgery, and abdominal aortic aneurysm repair. The study also identified demographic and clinical factors associated with smoking, such as age, sex, and geographical region. The findings suggest the need for targeted smoking cessation interventions and improvements in quality care for this patient population. [Extracted from the article]

The article discusses the importance of continuous monitoring during anesthesia and recovery to ensure patient safety. The authors conducted a survey to assess monitoring practices in the UK and found high compliance rates with recommended monitoring standards during general anesthesia. However, they also identified gaps in monitoring during sedation and patient transfers, which are known to be high-risk periods. Specifically, compliance with capnography guidelines during sedation or transfer was found to be poor. The authors emphasize the need for improved monitoring practices to prevent complications and ensure patient well-being. [Extracted from the article]

The article discusses the potential barriers to universal videolaryngoscopy for anaesthetists in training in the UK. The study found that there was significant variability in the use of videolaryngoscopy between hospitals, with usage ranging from 0% to 92.3%. Anaesthetists in training were more likely to use videolaryngoscopy at hospitals with lower overall usage, suggesting their support for its safety advantages. However, they may encounter differences in equipment available at each hospital, which could lead to unfamiliarity with the technical details. The article suggests that standardization of equipment and practice may be necessary to improve safety and familiarity if universal videolaryngoscopy is to be adopted. [Extracted from the article]

This article discusses the use of videolaryngoscopy for tracheal intubation and the barriers to its universal adoption in the UK. The authors conducted a retrospective analysis of a multicenter observational study to determine the baseline usage of videolaryngoscopy and identify any obstacles to its widespread use. They found that videolaryngoscopy was used in 27.7% of cases, with significant variation among hospital sites. The study also examined the influence of the primary airway manager's experience on the choice of laryngoscopy technique. The authors recommend further studies to assess the impact of guidelines on the use of videolaryngoscopy. [Extracted from the article]

This article discusses the issue of burnout among anaesthetic trainees in the UK, drawing on a study conducted in Switzerland. The study found a high prevalence of burnout among anaesthesia care providers, with a significant number reporting work-related errors and considering leaving the profession due to working conditions. Similar concerns have been raised by the British Medical Association and the Royal College of Anaesthetists. Efforts to address burnout include the BMA's Mental Wellbeing Charter and the RCoA's call for increased support and reassessment of workload and training demands. The authors advocate for international collaboration in addressing burnout, promoting work-life balance, and sharing best practices to support the well-being of healthcare professionals and improve patient care. [Extracted from the article]