BACKGROUND: Perioperative cardiac arrest is a rare complication with an incidence of around 1 in 1400 cases, but it carries a high burden of mortality reaching up to 70% at 30 days. Despite its specificities, guidelines for treatment of perioperative cardiac arrest are lacking. Gathering the available literature may improve quality of care and outcome of patients. METHODS: The PERIOPCA Task Force identified major clinical questions about the management of perioperative cardiac arrest and framed them into the therapy population [P], intervention [I], comparator [C], and outcome [O] (PICO) format. Systematic searches of PubMed, Embase, and the Cochrane Library for articles published until September 2020 were performed. Consensus-based treatment recommendations were created using the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) system. The strength of consensus among the Task Force members about the recommendations was assessed through a modified Delphi consensus process. RESULTS: Twenty-two PICO questions were addressed, and the recommendations were validated in two Delphi rounds. A summary of evidence for each outcome is reported and accompanied by an overall assessment of the evidence to guide healthcare providers. CONCLUSIONS: The main limitations of our work lie in the scarcity of good quality evidence on this topic. Still, these recommendations provide a basis for decision making, as well as a guide for future research on perioperative cardiac arrest.

1st Department of Neurology Medical School National and Kapodistrian University of Athens Athens Greece

AfterROSC Paris France

Center for Research and Development University Hospital Hradec Kralove Czech Republic

Department of Anesthesiology and Intensive Care E Meshalkin National Medical Research Center Novosibirsk Russian Federation

Department of Anesthesiology Faculty of Medicine University of Thessaly Larisa Greece

Department of Anesthesiology Intensive Care and Emergency Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico Milan Italy

Department of Anesthesiology Perioperative Medicine and Intensive Care Masaryk Hospital J E Purkinje University Usti Nad Labem Czech Republic

Department of Anesthesiology University Hospital of Larisa Biopolis Mezourlo 41110 Larisa Greece

Department of Health Sciences European University Cyprus Nicosia Cyprus

Department of Medical Sciences and Public Health University of Cagliari Cagliari Italy

Department of Pathophysiology and Transplantation University of Milan Milan Italy

Hellenic Society of Cardiopulmonary Resuscitation Athens Greece

Laboratory of Cardiopulmonary Pathophysiology Department of Cardiovascular Medicine Istituto di Ricerche Farmacologiche Mario Negri IRCCS Milan Italy

Medical Surgical Intensive Care Unit Centre Hospitalier de Versailles Site André Mignot 177 Rue de Versailles Le Chesnay France

National and Kapodistrian University of Athens Medical School Postgraduate Study Course Resuscitation Athens Greece

Novosibirsk State University Novosibirsk Russian Federation

Outcomes Research Consortium Cleveland OH 44195 USA

School of Medicine European University Cyprus Nicosia Cyprus

Service D'Anesthésie Et Réanimation Hôpital Européen Georges Pompidou Assistance Publique Hôpitaux de Paris 75015 Paris France

Service D'anesthésie Réanimation Chirurgicale DMU CARE DHU A TVB Assistance Publique Hôpitaux de Paris Hôpitaux Universitaires Henri Mondor Univ Paris Est Créteil Faculté de Santé 94010 Créteil France

U955 IMRB Equipe 03 Pharmacologie Et Technologies Pour Les Maladies Cardiovasculaires 94700 Maisons Alfort France

University Paris Saclay UVSQ INSERM CESP Team «PsyDev» Villejuif France

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