{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,18]],"date-time":"2026-08-18T00:44:00Z","timestamp":1787013840866,"version":"build-2736575974"},"reference-count":27,"publisher":"Wiley","issue":"5","license":[{"start":{"date-parts":[[2024,1,11]],"date-time":"2024-01-11T00:00:00Z","timestamp":1704931200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100001297","name":"Royal College of Anaesthetists","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100001297","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["associationofanaesthetists-publications.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Anaesthesia"],"published-print":{"date-parts":[[2024,5]]},"abstract":"<jats:title>Summary<\/jats:title>\n                  <jats:p>The 7th National Audit Project (NAP7) of the Royal College of Anaesthetists studied peri\u2010operative cardiac arrest. Among 59 cases reported as possible anaphylaxis, 33 (56%) were judged to be so by the review panel with high or moderate confidence. Causes in excluded cases included: isolated severe hypotension; bronchospasm; and oesophageal intubation. Severe bronchospasm leading to cardiac arrest was uncommon, but notably in one case led to a reported flat capnograph. In the baseline survey, anaesthetists estimated anaphylaxis as the cause of 10% of cases of peri\u2010operative cardiac arrests and to be among the four most common causes. In a year\u2010long registry of peri\u2010operative cardiac arrest, suspected anaphylaxis was the seventh most common cause accounting for 4% of reports. Initial management was most often with low\u2010dose intravenous adrenaline, and this was without complications. Both the NAP7 baseline survey and case registry provided evidence of reluctance to starting chest compressions when systolic blood pressure had fallen to below 50\u2009mmHg and occasionally even when it was unrecordable. All 33 patients were resuscitated successfully but one patient later died. The one death occurred in a relatively young patient in whom chest compressions were delayed. Overall, peri\u2010operative anaphylaxis leading to cardiac arrest occurred with a similar frequency and patterns of presentation, location, initial rhythm and suspected triggers in NAP7 as in the 6th National Audit Project (NAP6). Outcomes in NAP7 were generally better than for equivalent cases in NAP6.<\/jats:p>","DOI":"10.1111\/anae.16229","type":"journal-article","created":{"date-parts":[[2024,1,11]],"date-time":"2024-01-11T04:05:25Z","timestamp":1704945925000},"page":"498-505","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":9,"title":["Peri\u2010operative cardiac arrest due to suspected anaphylaxis as reported to the 7th National Audit Project of the Royal College of Anaesthetists"],"prefix":"10.1111","volume":"79","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-3654-497X","authenticated-orcid":false,"given":"T. M.","family":"Cook","sequence":"first","affiliation":[{"name":"Department of Anaesthesia and Intensive Care Medicine Royal United Hospitals Bath NHS Foundation Trust  Bath UK"},{"name":"School of Medicine University of Bristol  Bristol UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9488-4086","authenticated-orcid":false,"given":"A. D.","family":"Kane","sequence":"additional","affiliation":[{"name":"Department of Anaesthesia James Cook University Hospital  Middlesbrough UK"},{"name":"Royal College of Anaesthetists  London UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9479-0143","authenticated-orcid":false,"given":"R. A.","family":"Armstrong","sequence":"additional","affiliation":[{"name":"Royal College of Anaesthetists  London UK"},{"name":"University Hospitals Bristol and Weston NHS Foundation Trust  Bristol UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0864-3564","authenticated-orcid":false,"given":"E.","family":"Kursumovic","sequence":"additional","affiliation":[{"name":"Department of Anaesthesia and Intensive Care Medicine Royal United Hospitals Bath NHS Foundation Trust  Bath UK"},{"name":"Royal College of Anaesthetists  London UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5970-6073","authenticated-orcid":false,"given":"J.","family":"Soar","sequence":"additional","affiliation":[{"name":"Department of Anaesthesia and Intensive Care Medicine Southmead Hospital  Bristol UK"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2024,1,11]]},"reference":[{"key":"e_1_2_6_2_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.bja.2018.04.001"},{"key":"e_1_2_6_3_1","unstructured":"HarperNJN CookTM.Anaesthesia surgery and life\u2010threatening allergic reactions \u2010 summary of main findings. NAP6. London: Royal College of Anaesthetists. 2018.https:\/\/www.nationalauditprojects.org.uk\/downloads\/NAP6%20Chapter%206%20\u2010%20Summary%20of%20main%20findings.pdf(accessed 12\/12\/2023)."},{"key":"e_1_2_6_4_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.bja.2018.04.014"},{"key":"e_1_2_6_5_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.bja.2018.04.015"},{"key":"e_1_2_6_6_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.bja.2019.04.044"},{"key":"e_1_2_6_7_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.bja.2019.02.029"},{"key":"e_1_2_6_8_1","unstructured":"Resuscitation Council UK.Emergency treatment of anaphylaxis: guidelines for healthcare providers. London: RCUK. 2021.https:\/\/www.resus.org.uk\/sites\/default\/files\/2021\u201005\/Emergency%20Treatment%20of%20Anaphylaxis%20May%202021_0.pdf(accessed 30\/03\/2023)."},{"key":"e_1_2_6_9_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1365-2044.2008.05733.x"},{"key":"e_1_2_6_10_1","volume-title":"Quick Reference Handbook: Guidelines for Crises in Anaesthesia","author":"Association of Anaesthetists","year":"2022"},{"key":"e_1_2_6_11_1","unstructured":"At the Heart of the Matter. Report and Findings of the 7th National Audit Project of the Royal College of Anaesthetists Examining Perioperative Cardiac Arrest. Soar J Cook TM eds. London: Royal College of Anaesthetists 2023.https:\/\/www.rcoa.ac.uk\/sites\/default\/files\/documents\/2023\u201011\/24832%20RCoA_NAP7_Book%20%283%29.pdf(accessed 12\/12\/2023)."},{"key":"e_1_2_6_12_1","doi-asserted-by":"publisher","DOI":"10.1111\/anae.15856"},{"key":"e_1_2_6_13_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.resuscitation.2016.12.020"},{"key":"e_1_2_6_14_1","unstructured":"CookTM HarperNJN.Key findings and recommendations. NAP6. Royal College of Anaesthetists. 2018.https:\/\/www.nationalauditprojects.org.uk\/downloads\/NAP6%20Chapter%202%20\u2010%20Key%20findings%20and%20recommendations.pdf(accessed 15\/12\/2023)."},{"key":"e_1_2_6_15_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.resuscitation.2021.02.010"},{"key":"e_1_2_6_16_1","unstructured":"British Society for Allergy and Clinical Immunology.Peri\u2010operative Allergy Network.https:\/\/www.bsaci.org\/about\u2010bsaci\/bsaci\u2010council\u2010and\u2010executive\/bsaci\u2010subcommittees\/perioperative\u2010allergy\u2010network(accessed 15\/12\/2023)."},{"key":"e_1_2_6_17_1","unstructured":"CookTM.Deaths cardiac arrests profound hypotension and outcomes. NAP6. London: Royal College of Anaesthetists. 2018.https:\/\/www.nationalauditprojects.org.uk\/downloads\/NAP6%20Chapter%2012%20\u2010%20Deaths %20cardiac%20arrests %20profound%20hypotension%20and%20outcomes.pdf(accessed 15\/12\/2023)."},{"key":"e_1_2_6_18_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.bja.2019.11.005"},{"key":"e_1_2_6_19_1","doi-asserted-by":"publisher","DOI":"10.1111\/anae.16153"},{"key":"e_1_2_6_20_1","doi-asserted-by":"publisher","DOI":"10.1111\/anae.16154"},{"key":"e_1_2_6_21_1","doi-asserted-by":"publisher","DOI":"10.1111\/anae.15989"},{"key":"e_1_2_6_22_1","doi-asserted-by":"publisher","DOI":"10.1111\/anae.16155"},{"key":"e_1_2_6_23_1","doi-asserted-by":"publisher","DOI":"10.1111\/anae.16156"},{"key":"e_1_2_6_24_1","doi-asserted-by":"publisher","DOI":"10.1111\/anae.16157"},{"key":"e_1_2_6_25_1","unstructured":"KursumovicE SoarJ NolanJP et\u00a0al.NAP7 local coordinator survey of organisational preparedness for perioperative cardiac arrest. NAP7. 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