Incidence, Outcomes, and Risk Factors of Intraoperative Cardiac Arrest During Orthotopic Liver Transplantation
Issued Date
2024-01-01
Resource Type
ISSN
00411345
eISSN
18732623
Scopus ID
2-s2.0-85184768957
Journal Title
Transplantation Proceedings
Rights Holder(s)
SCOPUS
Bibliographic Citation
Transplantation Proceedings (2024)
Suggested Citation
Tovikkai P., Suphathamwit A., Raksakietisak M., Tovikkai C., Siriussawakul A., Sujirattanawimol K., Piriyapatsom A., Pongraweewan O., Tankul R., Hemtanon N., Boonyakarn S., Noinonthong C., Rattanaruangrit C., Soontarinka S. Incidence, Outcomes, and Risk Factors of Intraoperative Cardiac Arrest During Orthotopic Liver Transplantation. Transplantation Proceedings (2024). doi:10.1016/j.transproceed.2024.01.029 Retrieved from: https://repository.li.mahidol.ac.th/handle/20.500.14594/97272
Title
Incidence, Outcomes, and Risk Factors of Intraoperative Cardiac Arrest During Orthotopic Liver Transplantation
Author's Affiliation
Corresponding Author(s)
Other Contributor(s)
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.