The 7th National Audit Project (NAP7) baseline survey of individual anaesthetists: preparedness for and experiences of peri-operative cardiac arrest

The Royal College of Anaesthetists' 7th National Audit Project baseline survey assessed knowledge, attitudes, practices and experiences of peri-operative cardiac arrests among UK anaesthetists and Anaesthesia Associates. We received 10,746 responses, representing a 71% response rate. In-date training in adult and paediatric advanced life support was reported by 9646 (90%) and 7125 (66%) anaesthetists, respectively. There were 8994 (84%) respondents who were confident in leading a peri-operative cardiac arrest, with males more confident than females, but only 5985 (56%) were confident in leading a debrief and 7340 (68%) communicating with next of kin. In the previous two years, 4806 (46%) respondents had managed at least one peri-operative cardiac arrest, of which 321 (7%) and 189 (4%) of these events involved a child or an obstetric patient, respectively. Respondents estimated the most common causes of peri-operative cardiac arrest to be hypovolaemia, hypoxaemia and cardiac ischaemia, with haemorrhage coming fifth. However, the most common reported causes for the most recently attended peri-operative cardiac arrest were haemorrhage; (927, 20%); anaphylaxis (474, 10%); and cardiac ischaemia (397, 9%). Operating lists or shifts were paused or stopped after 1330 (39%) cardiac arrests and 1693 (38%) respondents attended a debrief, with ‘hot’ debriefs most common. Informal wellbeing support was relatively common (2458, 56%) and formal support was uncommon (472, 11%). An impact on future care delivery was reported by 196 (4%) anaesthetists, most commonly a negative psychological impact. Management of a peri-operative cardiac arrest during their career was reported by 8654 (85%) respondents. The overall impact on professional life was more often judged positive (2630, 30%) than negative (1961, 23%), but impact on personal life was more often negative

Methods of the 7th National Audit Project (NAP7) of the Royal College of Anaesthetists: peri-operative cardiac arrest

Cardiac arrest in the peri-operative period is rare but associated with significant morbidity and mortality. Current reporting systems do not capture many such events, so there is an incomplete understanding of incidence and outcomes. As peri-operative cardiac arrest is rare, many hospitals may only see a small number of cases over long periods, and anaesthetists may not be involved in such cases for years. Therefore, a large-scale prospective cohort is needed to gain a deep understanding of events leading up to cardiac arrest, management of the arrest itself and patient outcomes. Consequently, the Royal College of Anaesthetists chose peri-operative cardiac arrest as the 7th National Audit Project topic. The study was open to all UK hospitals offering anaesthetic services and had a three-part design. First, baseline surveys of all anaesthetic departments and anaesthetists in the UK, examining respondents' prior peri-operative cardiac arrest experience, resuscitation training and local departmental preparedness. Second, an activity survey to record anonymised details of all anaesthetic activity in each site over 4 days, enabling national estimates of annual anaesthetic activity, complexity and complication rates. Third, a case registry of all instances of peri-operative cardiac arrest in the UK, reported confidentially and anonymously, over 1 year starting 16 June 2021, followed by expert review using a structured process to minimise bias. The definition of peri-operative cardiac arrest was the delivery of five or more chest compressions and/or defibrillation in a patient having a procedure under the care of an anaesthetist. The peri-operative period began with the World Health Organization 'sign-in' checklist or first hands-on contact with the patient and ended either 24 h after the patient handover (e.g. to the recovery room or intensive care unit) or at discharge if this occured earlier than 24 h. These components described the epidemiology of peri-operative cardiac arrest in the UK and provide a basis for developing guidelines and interventional studies

Control of style-of-faulting on spatial pattern of earthquake-triggered landslides

Predictive mapping of susceptibility to earthquake-triggered landslides (ETLs) commonly uses distance to fault as spatial predictor, regardless of style-of-faulting. Here, we examined the hypothesis that the spatial pattern of ETLs is influenced by style-of-faulting based on distance distribution analysis and Fry analysis. The Yingxiu–Beichuan fault (YBF) in China and a huge number of landslides that ruptured and occurred, respectively, during the 2008 Wenchuan earthquake permitted this study because the style-of-faulting along the YBF varied from its southern to northern parts (i.e. mainly thrust-slip in the southern part, oblique-slip in the central part and mainly strike-slip in the northern part). On the YBF hanging-wall, ETLs at 4.4–4.7 and 10.3–11.5 km from the YBF are likely associated with strike- and thrust-slips, respectively. On the southern and central parts of the hanging-wall, ETLs at 7.5–8 km from the YBF are likely associated with oblique-slips. These findings indicate that the spatial pattern of ETLs is influenced by style-of-faulting. Based on knowledge about the style-of-faulting and by using evidential belief functions to create a predictor map based on proximity to faults, we obtained higher landslide prediction accuracy than by using unclassified faults. When distance from unclassified parts of the YBF is used as predictor, the prediction accuracy is 80%; when distance from parts of the YBF, classified according to style-of-faulting, is used as predictor, the prediction accuracy is 93%. Therefore, mapping and classification of faults and proper spatial representation of fault control on occurrence of ETLs are important in predictive mapping of susceptibility to ETLs