Predictive Factors for 24-h Survival After Perioperative Cardiopulmonary Resuscitation: Single-Center Retrospective Cohort Study

Background: Perioperative cardiac arrest (POCA) remains a major challenge in surgical settings, with low survival after cardiopulmonary resuscitation (CPR). This study aims to identify predictive factors for 24 h survival after CPR and cause of POCA. Method: A retrospective, single-center study was conducted on patients aged >= 18 years who experienced POCA and received CPR in the operating room or within 2 h postoperatively at Chiang Mai University Hospital from 2010 to 2019. The multivariable analysis of independent survival predictors was performed using risk regression models. Results: There were 288 cases of cardiopulmonary arrest requiring CPR, with 61 patients surviving. Significant predictors of survival after perioperative CPR included the American Society of Anesthesiologists physical status classification (ASA) 1-2 (RR 2.53; 95%CI 1.69-3.77; p < 0.001), preoperative hemoglobin >= 8 g/dL (RR 2.27; 95%CI 1.05-4.89; p = 0.036), preoperative oxygen saturation >= 90% (spontaneous breathing in room air) (RR 3.19; 95%CI 1.21-8.41; p = 0.019), initial end-tidal carbon dioxide between 35 and 45 mmHg (RR 1.55; 95%CI 0.98-2.44; p = 0.059), and duration of CPR <= 30 min (RR 3.68; 95%CI 1.51-8.98; p = 0.004). The major cause of POCA was hypovolemia (74.30%). Conclusions: This study identifies several critical predictors for 24 h survival following POCA, which can inform pre-operative optimization and perioperative management. Timely interventions, such as blood transfusions and volume resuscitation, are crucial in improving survival outcomes, particularly in trauma and high-risk patients. Further multi-center studies are needed to validate these findings and explore long-term outcomes to refine perioperative cardiac arrest management.