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5. Cardiac arrest in obstetric patients receiving anaesthetic care: results from the 7th National Audit Project of the Royal College of Anaesthetists.

Author

Lucas, D. N., Kursumovic, E., Cook, T. M., Kane, A. D., Armstrong, R. A., Plaat, F., and Soar, J.

Subjects
CARDIAC arrest, ANESTHESIOLOGISTS, PATIENT-controlled analgesia, ANESTHETICS, EPIDURAL analgesia, ADVANCED cardiac life support, VAGINAL fistula
Abstract

Summary: The 7th National Audit Project (NAP7) of the Royal College of Anaesthetists studied peri‐operative cardiac arrest. Additional inclusion criteria for obstetric anaesthesia were: cardiac arrest associated with neuraxial block performed by an anaesthetist outside the operating theatre (labour epidural analgesia); and cardiac arrest associated with remifentanil patient‐controlled analgesia. There were 28 cases of cardiac arrest in obstetric patients, representing 3% of all cardiac arrests reported to NAP7, giving an incidence of 7.9 per 100,000 (95%CI 5.4–11.4 per 100,000). Obstetric patients were approximately four times less likely to have a cardiac arrest during anaesthesia care than patients having non‐obstetric surgery. The single leading cause of peri‐operative cardiac arrest in obstetric patients was haemorrhage, with underestimated severity and inadequate early resuscitation being contributory factors. When taken together, anaesthetic causes, high neuraxial block and bradyarrhythmia associated with spinal anaesthesia were the leading causes overall. Two patients had a cardiac arrest related to labour neuraxial analgesia. There were no cardiac arrests related to failed airway management or remifentanil patient‐controlled analgesia. [ABSTRACT FROM AUTHOR]

Published
2024
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6. Organisation of UK hospitals and anaesthetic departments in the treatment of peri‐operative cardiac arrest: an analysis from the 7th National Audit Project (NAP7) local co‐ordinator baseline survey.

Author

Kursumovic, E., Soar, J., Nolan, J. P., Plaat, F., Kane, A. D., Armstrong, R. A., Davies, M. T., Oglesby, F. C., Cortes, L., Taylor, C., Moppett, I. K., Agarwal, S., Cordingley, J., Dorey, J., Finney, S. J., Kunst, G., Lucas, D. N., Nickols, G., Mouton, R., and Patel, B.

Subjects
CRITICALLY ill children, CRITICALLY ill patient care, CARDIAC arrest, HOSPITAL care of children, ANESTHETICS, PEDIATRIC intensive care, OPERATING rooms
Abstract

Summary: We report the results of the Royal College of Anaesthetists' 7th National Audit Project organisational baseline survey sent to every NHS anaesthetic department in the UK to assess preparedness for treating peri‐operative cardiac arrest. We received 199 responses from 277 UK anaesthetic departments, representing a 72% response rate. Adult and paediatric anaesthetic care was provided by 188 (95%) and 165 (84%) hospitals, respectively. There was no paediatric intensive care unit on‐site in 144 (87%) hospitals caring for children, meaning transfer of critically ill children is required. Remote site anaesthesia is provided in 182 (92%) departments. There was a departmental resuscitation lead in 113 (58%) departments, wellbeing lead in 106 (54%) and departmental staff wellbeing policy in 81 (42%). A defibrillator was present in every operating theatre suite and in all paediatric anaesthesia locations in 193 (99%) and 149 (97%) departments, respectively. Advanced airway equipment was not available in: every theatre suite in 13 (7%) departments; all remote locations in 103 (57%) departments; and all paediatric anaesthesia locations in 23 (15%) departments. Anaesthetic rooms were the default location for induction of anaesthesia in adults and children in 148 (79%) and 121 (79%) departments, respectively. Annual updates in chest compressions and in defibrillation were available in 149 (76%) and 130 (67%) departments, respectively. Following a peri‐operative cardiac arrest, debriefing and peer support programmes were available in 154 (79%) and 57 (29%) departments, respectively. While it is likely many UK hospitals are very well prepared to treat anaesthetic emergencies including cardiac arrest, the survey suggests this is not universal. [ABSTRACT FROM AUTHOR]

Published
2023
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10. Methods of the 7 th National Audit Project ( NAP7 ) of the Royal College of Anaesthetists: peri‐operative cardiac arrest

Author

Kane, A. D., primary, Armstrong, R. A., additional, Kursumovic, E., additional, Cook, T. M., additional, Oglesby, F. C., additional, Cortes, L., additional, Moppett, I. K., additional, Moonesinghe, S. R., additional, Agarwal, S., additional, Bouch, D. C., additional, Cordingley, J., additional, Davies, M. T., additional, Dorey, J., additional, Finney, S. J., additional, Kunst, G., additional, Lucas, D. N., additional, Nickols, G., additional, Mouton, R., additional, Nolan, J. P., additional, Patel, B., additional, Pappachan, V. J., additional, Plaat, F., additional, Samuel, K., additional, Scholefield, B. R., additional, Smith, J. H., additional, Varney, L., additional, Vindrola‐Padros, C., additional, Martin, S., additional, Wain, E. C., additional, Kendall, S. W., additional, Ward, S., additional, Drake, S., additional, Lourtie, J., additional, Taylor, C., additional, and Soar, J., additional

Published
2022
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19. Ergonomics in the anaesthetic workplace

Author

Bailey, C. R., primary, Radhakrishna, S., additional, Asanati, K., additional, Dill, N., additional, Hodgson, K., additional, McKeown, C., additional, Pawa, A., additional, Plaat, F., additional, and Wilkes, A., additional

Published
2021
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21. 5th National Audit Project (NAP5) on accidental awareness during general anaesthesia: summary of main findings and risk factors†‡

Author

Pandit, J. J., Andrade, J., Bogod, D. G., Hitchman, J. M., Jonker, W. R., Lucas, N., Mackay, J. H., Nimmo, A. F., OʼConnor, K., OʼSullivan, E. P., Paul, R. G., Palmer, J. H. M. G., Plaat, F., Radcliffe, J. J., Sury, M. R. J., Torevell, H. E., Wang, M., Hainsworth, J., Cook, T. M., Armstrong, James, Bird, Jonathan, Eddy, Alison, Harrop-Griffiths, William, Love, Nicholas, Mahajan, Ravi, Mallick, Abhiram, Barker, Ian, Kirkpatrick, Anahita, Molodynski, Jayne, Poonnusamy, Karthikeyen, Moonesinghe, Ramani, Weatherill, David, Smith, David, Humphrey, Maddy, Casserly, Mary, Drake, Sharon, and Rangasami, Jairaj

Published
2014
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23. 5th National Audit Project (NAP5) on accidental awareness during general anaesthesia: patient experiences, human factors, sedation, consent, and medicolegal issues†‡

Author

Cook, T. M., Andrade, J., Bogod, D. G., Hitchman, J. M., Jonker, W. R., Lucas, N., Mackay, J. H., Nimmo, A. F., OʼConnor, K., OʼSullivan, E. P., Paul, R. G., Palmer, J. H. M. G., Plaat, F., Radcliffe, J. J., Sury, M. R. J., Torevell, H. E., Wang, M., Hainsworth, J., Pandit, J. J., Armstrong, James, Bird, Jonathan, Eddy, Alison, Harrop-Griffiths, William, Love, Nicholas, Mahajan, Ravi, Mallick, Abhiram, Barker, Ian, Kirkpatrick, Anahita, Molodynski, Jayne, Poonnusamy, Karthikeyen, Moonesinghe, Ramani, Weatherill, David, Smith, David, Humphrey, Maddy, Drake, Sharon, Casserly, Mary, and Rangasami, Jairaj

Published
2014
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24. The 5th National Audit Project (NAP5) on accidental awareness during general anaesthesia: patient experiences, human factors, sedation, consent and medicolegal issues

Author

Cook, T. M., Andrade, J., Bogod, D. G., Hitchman, J. M., Jonker, W. R., Lucas, N., Mackay, J. H., Nimmo, A. F., OʼConnor, K., OʼSullivan, E. P., Paul, R. G., MacPalmer, J. H. G., Plaat, F., Radcliffe, J. J., Sury, M. R. J., Torevell, H. E., Wang, M., Hainsworth, J., and Pandit, J. J.

Published
2014
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37. The identification of key indicators to drive quality improvement in obstetric anaesthesia: results of the Obstetric Anaesthetists' Association/National Perinatal Epidemiology Unit collaborative Delphi project

Author

Bamber, JH, Lucas, DN, Plaat, F, Allin, B, Knight, M, and Group, Collaborators for the Obstetric Anaesthetists’ Association Quality and Outcomes Working

Subjects
Adult, Quality management, Referral, Delphi Technique, media_common.quotation_subject, Point-of-Care Systems, Delphi method, Guidelines as Topic, Midwifery, 03 medical and health sciences, 0302 clinical medicine, 030202 anesthesiology, Pregnancy, medicine, Anesthesia, Obstetrical, Humans, Quality (business), Maternal Health Services, 030212 general & internal medicine, Grading (education), media_common, Quality Indicators, Health Care, Estimation, business.industry, Cesarean Section, Benchmarking, medicine.disease, Quality Improvement, Analgesia, Epidural, Anesthesiology and Pain Medicine, Scale (social sciences), Health Care Surveys, Anesthetists, Analgesia, Obstetrical, Female, Medical emergency, Post-Dural Puncture Headache, business
Abstract

A three-stage Delphi survey process was undertaken to identify the quality indicators considered the most relevant to obstetric anaesthesia. The initial quality indicators assessed were derived from national peer-reviewed publications and were divided into service provision, service quality and clinical outcomes. A range of stakeholders were invited to participate and divided into three panels: obstetric anaesthetists; other maternity care health professionals; and women who had used maternity services. In total, 133 stakeholders registered to participate with 80% completing all three phases of the survey process. Participants ranked indicators for their relative importance using the grading of recommendations assessment, development and evaluation scale. From an initial list of 31 quality indicators, 11 indicators were rated as extremely important by > 90% of participants in at least two panels. These 11 indicators were presented to stakeholders; they were asked to vote for the five indicators they considered most relevant and useful for assessing and benchmarking the quality of obstetric anaesthesia provided. The indicators chosen were: the percentage of women who had an epidural/combined spinal-epidural for labour analgesia with accidental dural puncture; the presence of guidelines for the referral of patients to an anaesthetist for antenatal review; whether there are dedicated elective caesarean section lists; the availability of point-of-care testing for estimation of haemoglobin concentration; and the percentage of epidurals for labour analgesia that provided adequate pain relief within 45 min of the start of epidural insertion. These indicators may be used for quality improvement and national benchmarking to support the implementation of quality standards in obstetric anaesthesia.

Published
2019

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