Abstract No. 281 - Medical emergencies and cardiopulmonary arrests in interventional radiology

Abstract

Purpose To characterize the circumstances and outcomes of medical emergencies (ME) and cardiopulmonary arrests (CPA) in patients undergoing IR procedures. Materials and Methods Retrospective review of all ME/CPAs occurring between July 2006 and Dec. 2011 was performed. Procedure type, technical outcome, complications, etiology and location of ME/CPA, event outcome, and post-event mortality were all collected. Frequency of CPA/ME by procedure type and relative risk (RR) of ME/CPA were calculated. Results 58 events occurred during 38,927 procedures. Complete records were available for 55(12 CPA, 43 ME) occurring in 53 patients (mean age 63yrs, 58.5% M) during 37 inpatient (10 CPA, 27 ME) and 18 outpatient (2CPA, 16ME) encounters. Frequency and location of ME/CPA are summarized in the Table. Seven events (13%) occurred before start of the procedure. 18 ME/CPA (33%) occurred in the holding area. 35 procedures (64%) were completed successfully. All patients survived the event. From the time of the event, 42 patients (76%) were alive at discharge, 37 (67%) at 1 month, 26 (47%) at 3 months, and 23 (42%) at 1 year. Procedural complications were attributed as the cause of 22 ME (51%) and 1 CPA (8%, p=0.018). Of the 12 CPAs, 9 occurred in hemodialysis (HD) access cases (75%). The RR of a ME/CPA occurring during HD access case compared to all other cases was 5.2 (CI=3.02-8.95). Conclusion Incidence of ME/CPAs in patients undergoing IR procedures is low, yet 1-year mortality following these events is high. Vigilant observation of patients in the holding area is warranted given frequency of ME/CPAs in this location. MEs are significantly more likely to be directly attributed to a procedural complication then CPAs. The RR of ME/CPAs is significantly higher in HD access interventions.