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Review
. 2024 Jun 1;138(6):1215-1232.
doi: 10.1213/ANE.0000000000006664. Epub 2023 Oct 3.

Causes of Perioperative Cardiac Arrest: Mnemonic, Classification, Monitoring, and Actions

Lingzhong Meng  1 , Mads Rasmussen  2 , Arnoley S Abcejo  3 , Deyi M Meng  4 , Chuanyao Tong  5 , Hong Liu  6
Affiliations
Free article
Review

Causes of Perioperative Cardiac Arrest: Mnemonic, Classification, Monitoring, and Actions

Lingzhong Meng et al. Anesth Analg. .
Free article

Abstract

Perioperative cardiac arrest (POCA) is a catastrophic complication that requires immediate recognition and correction of the underlying cause to improve patient outcomes. While the hypoxia, hypovolemia, hydrogen ions (acidosis), hypo-/hyperkalemia, and hypothermia (Hs) and toxins, tamponade (cardiac), tension pneumothorax, thrombosis (pulmonary), and thrombosis (coronary) (Ts) mnemonic is a valuable tool for rapid differential diagnosis, it does not cover all possible causes leading to POCA. To address this limitation, we propose using the preload-contractility-afterload-rate and rhythm (PCARR) construct to categorize POCA, which is comprehensive, systemic, and physiologically logical. We provide evidence for each component in the PCARR construct and emphasize that it complements the Hs and Ts mnemonic rather than replacing it. Furthermore, we discuss the significance of utilizing monitored variables such as electrocardiography, pulse oxygen saturation, end-tidal carbon dioxide, and blood pressure to identify clues to the underlying cause of POCA. To aid in investigating POCA causes, we suggest the Anesthetic care, Surgery, Echocardiography, Relevant Check and History (A-SERCH) list of actions. We recommend combining the Hs and Ts mnemonic, the PCARR construct, monitoring, and the A-SERCH list of actions in a rational manner to investigate POCA causes. These proposals require real-world testing to assess their feasibility.

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Conflict of interest statement

The authors declare no conflicts of interest.

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