Girardi and Barie review a very large series of patients undergoing operations to evaluate the frequency of intraoperative cardiac arrest and to document the clinical outcomes. That the risk of cardiac arrest is very low (only one in nearly 7000 cases) is heartening. Results of resuscitation in patients with short duration of clinical cardiac arrest or with easily correctable problems (hypoxia caused by airway obstruction) are, predictably, better. That patients who are in trouble clinically (hypotensive or bleeding) at the time of the arrest or before the operation (operations for sepsis and multiple organ failure) do worse is also not surprising.
Much of the credit for these improved results goes to advances in intraoperative management by anesthesiologists. Anesthesia techniques that were developed to facilitate complex operations on patients requiring open-heart surgery and solidorgan transplantation have been broadly applied. Some of the improvement in results may be owing to improved preoperative