Intraoperative cardiac arrest: A retrospective analysis of incidence, etiologies and mortality in a university hospital in Madagascar

Background: Cardiac arrest occurring in the operating room is a rare but severe complication associated with high mortality. Data from Madagascar remain limited. This study aimed to describe the incidence, probable causes, and outcomes of patients who experienced intraoperative cardiac arrest at the University Hospital Center Professor Zafisaona Gabriel of Mahajanga.
Methods: A retrospective descriptive study was conducted from June 1, 2019, to June 30, 2024. All patients who experienced a documented cardiac arrest in the operating room during the study period were included. Data were collected from operating room registers, anesthesia records, operative reports, and intensive care unit files.
Results: Among 8,900 anesthetic procedures, 49 patients experienced cardiac arrest, corresponding to an incidence of 0.55% or 5.5 per 1,000 anesthetics. The mean age was 24.7 years, and females accounted for 73.5% of cases. Most patients were classified as American Society of Anesthesiologists physical status III and underwent emergency surgery. The main identified causes were hemorrhagic shock (38.8%) and hypoxia (30.6%). Return of spontaneous circulation was achieved in 83.7% of patients. Overall in-hospital mortality was 59.2%.
Conclusion: Intraoperative cardiac arrest mainly occurred in high-risk patients undergoing emergency surgery. Hemorrhagic shock and hypoxia were the leading causes. Despite a high rate of return of spontaneous circulation, hospital mortality remained substantial.