TOPLINE

Cardiac arrest complicated 1 in 10,125 inpatient endoscopic procedures. Congestive heart failure was associated with increased odds of intraprocedural cardiac arrest. However, in-hospital mortality was lower for endoscopic cardiac arrests than for other cardiac arrests.

METHODOLOGY

• Endoscopy is usually considered safe, but cardiac arrest is its most severe cardiopulmonary complication. Still, the rate and outcomes of cardiac arrest during endoscopic procedures in the US are not well understood.
• Researchers conducted a retrospective cross-sectional analysis using data from the National Inpatient Sample in the US (2016-2023), identifying adult hospitalizations involving cardiac arrest during endoscopic procedures.
• A total of 11,137,008 inpatient endoscopic procedures were analyzed and categorized as upper endoscopy, endoscopic retrograde cholangiopancreatography, or colonoscopy. Documentation of cardiopulmonary resuscitation (CPR) on the same day as the procedure, along with a diagnostic code for cardiac arrest that occurred during the procedure, was required.
• The study assessed the frequency of cardiac arrest during inpatient endoscopic procedures and associated outcomes — in-hospital mortality, need for renal replacement therapy or tracheostomy, length of stay, and cost.
• Patient factors associated with cardiac arrest during endoscopic procedures were identified, and outcomes among patients who experienced cardiac arrest during endoscopy were compared with those among patients with other in-hospital cardiac arrests.

TAKEAWAY

• Among the inpatient endoscopic procedures, 1110 were complicated by cardiac arrest (mean age of the cohort, 69.2 years; 59.0% male patients; 60.2% White patients), corresponding to 1 cardiac arrest per 10,125 procedures.
• Congestive heart failure showed the strongest association with cardiac arrest during endoscopy (adjusted odds ratio [aOR], 2.78; P < .001). Other conditions associated with cardiac arrest were coronary artery disease, chronic kidney disease, and sepsis.
• Overall in-hospital mortality was lower among patients who experienced cardiac arrest during an endoscopic procedure than among those who experienced other in-hospital cardiac arrests (30.6% vs 71.0%; aOR, 0.17; P < .001). Rates of renal replacement therapy and tracheostomy did not differ significantly between the two cardiac arrest groups.
• Among patients who survived to discharge, the mean length of stay was shorter and hospitalization costs were lower in the endoscopic cardiac arrest group than in the other in-hospital cardiac arrest group (P < .001 and P < .05, respectively).

IN PRACTICE

“Cardiac arrest events were increased in upper endoscopies compared to colonoscopies in our cohort…. We hypothesize that patients undergoing upper endoscopy were more likely to receive propofol-based sedation than those who underwent colonoscopy and that this may have contributed to the increased risk in upper endoscopies,” the authors wrote.

“We suspect that the improved outcome may be due to more reversible causes being the underlying etiology and faster initiation of CPR,” they added.

SOURCE

This study was led by Spencer R. Goble, University of Minnesota, Minneapolis. It was published online in Digestive Diseases and Sciences.

LIMITATIONS

The administrative database did not include narrative assessments affecting the identification of the cause of cardiac arrest. It also did not provide information on duration and location of the procedure, indication of the procedure (therapeutic vs diagnostic), or urgency (emergency vs elective), thereby preventing the understanding of the overall complexity of the procedure. Researchers were unable to determine the type of sedation patients received, the experience level of the person giving the sedation, or the American Society of Anesthesiologists class of patients.

DISCLOSURES

This study did not receive any grant support. The authors declared having no competing interests.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.