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LETTER TO THE EDITOR

Cardiac Arrest During Neuraxial Anesthesia: Are All Databases Comparable?

Boston Medical Center, Boston, MA, donlam{at}fastmail.us

To the Editor:

In a recent article, Kopp et al. (1) claim the following:

"The survival rate among these patients was similar to the overall rate for our series and suggests that neither the patient population nor the neurological outcome of patients included in the ASA Closed Claims Project is representative of those who arrest during neuraxial block."

This makes little sense because:

1. The Closed Claims Database (CCDB) (2,3) is 60 times larger than Kopp's.
   
2. The outcome at the Mayo Clinic should be better than at the varied hospitals represented in the CCDB, where fewer resources are available compared with a tertiary care facility.
   
3. The distribution of serious outcomes in the CCDB does not necessarily match those from a single institution's sample.
   
4. Because the CCDB arose from malpractice claims, there can be no meaningful statistical comparisons with the Mayo Clinic's, where cases not involving a malpractice claim are equally likely to be included as those that do.
   

If all cardiac arrests owing to neuraxial anesthesia occurred in a hospital like the Mayo Clinic, the outcomes might be more favorable than reported by the CCDB. However, the CCDB appears sound and is probably more representative of what happens in the general population.

References

1. Kopp SL, Horlocker TT, Warner ME, et al. Cardiac arrest during neuraxial anesthesia: frequency and predisposing factors associated with survival. Anesth Analg 2005;100:855–65.[Abstract/Free Full Text]
2. Lee LA, Posner KL, Domino KB, et al. Injuries associated with regional anesthesia in the 1980s and 1990s: a closed claims analysis. Anesthesiology 2004;101:143–52.[Web of Science][Medline]
3. Caplan RA, Ward RJ, Posner K, Cheney FW. Unexpected cardiac arrest during spinal anesthesia: a closed claims analysis of predisposing factors. Anesthesiology 1988;68:5–11.[Web of Science][Medline]

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