Arret cardiaque postoperatoire a Lome (Togo): Aspects epidemiologiques, therapeutiques et evolutifs

Objectif: L’objectif de cette etude etait de determiner l’incidence et decrire la prise en charge des arrets cardiaques postoperatoires.Patients et methodes: Il s’agissait d’une etude retrospective et descriptive des arrets cardiaques survenus au cours des 48 premieres heures postoperatoires, entre le 1er janvier 2009 et le 31 decembre 2013 au CHU Sylvanus Olympio de Lome.Resultats: Seize mille trois cents soixante-quinze sur 27644 patients operes (59,2%) etaient admis en salle de surveillance post interventionnelle ou en reanimation. Parmi eux, 75 patients ont eu un arret cardiaque postoperatoire, dont 50 de sexe feminin (66,7%). Ils avaient beneficie d’une intervention obstetricale (48%), digestive (46,7%) et traumatologique ou orthopedique (5,3%) sous anesthesie generale (93,3%) ou rachianesthesie (6,7%). Les urgences representaient 93,3% dont les peritonites (30,7%), l’hemorragie du post-partum (17,3%) et l’eclampsie (13,3%). Quarante et un patients (54,7%) etaient classes ASA 2 ou plus et 30 patients (40%) n’avaient pas eu de consultation ou d’evaluation preanesthesique. Le choc hemorragique (26,7%), les detresses respiratoires (18,7%) et le choc septique (6,7%) etaient les causes de l’arret cardiaque. Dans 48% des cas la cause n’etait pas identifiee. La reanimation comprenait : le massage cardiaque externe dans tous les cas, la ventilation au masque facial (60%), l'intubation tracheale (50,7%), la ventilation mecanique (21,3%) et l’administration d’adrenaline (78,7%). Soixante-dix patients (93,3%) sont decedes malgre la reanimation.Conclusion: L’arret cardiaque postoperatoire est frequent au CHU Sylvanus Olympio de Lome. Sa prise en charge presente des insuffisances et sa mortalite est elevee. Mots cles : Arret cardiaque, postoperatoire, choc, reanimation, Lome. Objective: This study aimed to determine the incidence and describe the management of postoperative cardiac arrests. Patients and methods: A retrospective and descriptive study was conducted about cardiac arrest occurring within 48 hours postoperative period, between January 1, 2009 and December 31, 2013 at Sylvanus Olympio University Hospital of Lome. Results: Sixteen thousand three hundred seventy-five out of 27,644 operated patients (59.2%) were admitted to the recovery or intensive care unit. Seventy-five patients had cardiac arrest post operatively. Among them, 50 were females (66.7%). They underwent an obstetric (48%), digestive (46.7%) and trauma or orthopedic (5.3%) procedure under general anesthesia (93.3%) or spinal anesthesia (6.7%). Emergencies accounted for 93.3%,including peritonitis (30.7%), postpartum hemorrhage (17.3%) and eclampsia (13.3%). Forty-one patients (54.7%) were classified as ASA 2 or higher and 30 patients had no preanesthetic consultation or assessment. Hemorrhagic shock (26.7%), respiratory distress (18.7%) and septic shock (6.7%) were the causes of cardiac arrest. In 48% the cause was not identified. Resuscitation included: chest compressions, manual ventilation (60%), tracheal intubation (50.7%), mechanical ventilation (21.3%) and adrenalin injection intravenously (78.7%). Seventy patients (93.3%) were deceased despite resuscitation. Conclusion: Postoperative cardiac arrest is common at Sylvanus Olympio University Hospital of Lome. Its management is deficient and mortality rate is high. Keywords: Cardiac arrest, postoperative, shock, resuscitation, Lome.