Incidence, Mortality, and Characteristics of 18 Pediatric Perioperative Cardiac Arrests: An Observational Trial From 22,650 Pediatric Anesthesias in a German Tertiary Care Hospital.

Published on Sep 1, 2021in Anesthesia & Analgesia4.305
· DOI :10.1213/ANE.0000000000005296
Gerrit Jansen1
Estimated H-index: 1
(FUI: Foundation University, Islamabad),
Rainer Borgstedt1
Estimated H-index: 1
+ 4 AuthorsSebastian Rehberg22
Estimated H-index: 22
BACKGROUND Recently, a very low incidence of 3 per 10,000 and a mortality of 30% were reported for pediatric perioperative cardiac arrest (POCA). However, high-risk patients, namely children already anesthetized on the intensive care unit (ICU), were excluded. This study investigates the incidence and mortality of POCA in children in whom anesthesia was induced in the ICU or in the operating room using real-world data. In addition, different classifications of POCA were compared with respect to outcome relevance. METHODS This is a retrospective observational study conducted at a German level 1 perinatal center and tertiary care hospital between 2008 and 2018. Children ≤15 years who underwent an anesthetic procedure and suffered from POCA (defined as any condition requiring chest compressions and/or defibrillation) from the beginning of care provided by an anesthesiologist to 60 minutes after anesthesia or sedation were included. Primary end points were incidence and mortality of POCA in children with anesthesia induced in the ICU versus in the operating room. Secondary end points included incidences and outcomes with respect to the pathophysiological cause (respiratory versus circulatory associated). RESULTS There were 18 POCA during 22,650 anesthetic procedures (incidence 7.9 per 10,000; 95% confidence interval [CI], 4.7-12.5). Thirty-day mortality was 3.5 per 10,000 (95% CI, 1.5-6.9). Incidence and mortality were higher in children in whom anesthesia was induced in the ICU versus in the operating room (incidence: 131.6; 95% CI, 57 to 257.6 versus 4.5; 95% CI, 2.2-8.3; P < .001; and mortality: 82.2; 95% CI, 26.7-190.8 versus 1.4; 95% CI, 0.3-3.9; P < .001). Mortality in circulatory-induced POCA (n = 8; 44%) was 100%, in respiratory-induced POCA (n = 9; 50%) 0% (P < .001). CONCLUSIONS Children with anesthesia induction in the ICU represent a high-risk population for POCA and POCA-associated mortality. POCA classification should be based on the individual cause (respiratory versus circulatory) rather than on the perioperative phase or the responsible specialty.
#1Elizabeth A. Hunt (JHUSOM: Johns Hopkins University School of Medicine)H-Index: 37
#2Jordan Duval-Arnould (JHUSOM: Johns Hopkins University School of Medicine)H-Index: 13
Last. Lars W. Andersen (BIDMC: Beth Israel Deaconess Medical Center)H-Index: 29
view all 10 authors...
Importance Delayed defibrillation (>2 minutes) in adult in-hospital cardiac arrest (IHCA) is associated with worse outcomes. Little is known about the timing and outcomes of defibrillation in pediatric IHCA. Objective To determine whether time to first defibrillation attempt in pediatric IHCA with a first documented shockable rhythm is associated with survival to hospital discharge. Design, Setting, and Participants In this cohort study, data were obtained from the Get With The Guidelines–Resusc...
15 CitationsSource
#1Robert ChristensenH-Index: 11
#2Angela C LeeH-Index: 1
Last. Jeffrey P. Morray (Boston Children's Hospital)H-Index: 8
view all 6 authors...
BACKGROUND:Pediatric perioperative cardiac arrest (CA) is a rare but catastrophic event. This case–control study aims to analyze the causes, incidence, and outcomes of all pediatric CA reported to Wake Up Safe. Factors associated with CA and mortality after arrest are examined and possible strategie
22 CitationsSource
#1Thomas Engelhardt (Aberd.: University of Aberdeen)H-Index: 24
#2Katalin Virag (University of Szeged)H-Index: 6
Last. Walid Habre (University of Geneva)H-Index: 31
view all 4 authors...
Abstract Background Critical respiratory events are common in children in the peri-anaesthetic period and are caused by airway and ventilation management difficulties. We aimed to analyse current European paediatric airway management practices and identify the incidence and potential consequences of difficult airway management. Methods We performed a secondary analysis of airway and ventilation management details of the European multicentre observational trial (Anaesthesia PRactice in Children O...
40 CitationsSource
#1Andreas Hohn (University of Cologne)H-Index: 6
Last. Stephan A. PadoschH-Index: 8
view all 4 authors...
BACKGROUNDIn recent decades, the incidences of anaesthesia-related perioperative mortality and adverse outcomes have decreased drastically. However, to date, data on perioperative cardiac arrest and risk factors of perioperative cardiac arrest from European countries are scarce.OBJECTIVESTo determin
12 CitationsSource
#1Walid Habre (University of Geneva)H-Index: 31
#2Nicola Disma (Istituto Giannina Gaslini)H-Index: 18
Last. Pierre HarletH-Index: 3
view all 12 authors...
Summary Background Little is known about the incidence of severe critical events in children undergoing general anaesthesia in Europe. We aimed to identify the incidence, nature, and outcome of severe critical events in children undergoing anaesthesia, and the associated potential risk factors. Methods The APRICOT study was a prospective observational multicentre cohort study of children from birth to 15 years of age undergoing elective or urgent anaesthesia for diagnostic or surgical procedures...
230 CitationsSource
Massive transfusions occur frequently in pediatric trauma patients, among some children undergoing surgery, or in children with critical illness. Over the last years, many authors have studied different aspects of massive transfusions, starting with an operative definition. Some information is available on transfusion strategies and adjunctive treatments. Areas that require additional investigation include: studies to assess which children benefit from transfusion protocols based on fixed ratios...
10 CitationsSource
#2Wangles Pignaton (UNESP: Sao Paulo State University)H-Index: 6
Last. Leandro Gobbo Braz (UNESP: Sao Paulo State University)H-Index: 20
view all 6 authors...
This systematic review of the Brazilian and worldwide literature aimed to evaluate the incidence and causes of perioperative and anesthesia-related mortality in pediatric patients. Studies were identified by searching EMBASE (1951-2011), PubMed (1966-2011), LILACS (1986-2011), and SciElo (1995-2011). Each paper was revised to identify the author(s), the data source, the time period, the number of patients, the time of death, and the perioperative and anesthesia-related mortality rates. Twenty tr...
65 CitationsSource
#1Benjamin F H van der Griend (Christchurch Hospital)H-Index: 1
#2Nichole A. ListerH-Index: 1
Last. Andrew DavidsonH-Index: 36
view all 7 authors...
BACKGROUND: Mortality is a basic measure for quality and safety in anesthesia. There are few anesthesia-related mortality data available for pediatric practice. Our objective for this study was to determine the incidence of 24-hour and 30-day mortality after anesthesia and to determine the incidence and nature of anesthesia-related mortality in pediatric practice at a large tertiary institution. METHODS: Children 18 years old who had an anesthetic between January 1, 2003, and August 30, 2008, at...
151 CitationsSource
#1Chandra Ramamoorthy (Stanford University)H-Index: 32
#2Charles M. Haberkern (UW: University of Washington)H-Index: 24
Last. Jeffrey P. Morray (Boston Children's Hospital)H-Index: 8
view all 7 authors...
BACKGROUND:From 1994 to 2005, the Pediatric Perioperative Cardiac Arrest Registry collected data on 373 anesthesia-related cardiac arrests (CAs) in children, 34% of whom had congenital or acquired heart disease (HD).METHODS:Nearly 80 North American institutions that provide anesthesia for children v
256 CitationsSource
#1Aliya Ahmed (Aga Khan University)H-Index: 7
#2Mohammed K. Ali (Aga Khan University)H-Index: 70
Last. Fauzia Anis Khan (Aga Khan University)H-Index: 18
view all 4 authors...
Summary Objective/Aim: To study the incidence, causes, and outcome of perioperative cardiac arrests in children at a university teaching hospital with an aim of improving quality of care. Background: Analysis of anesthesia-related complications is routinely performed by most anesthesia departments to make prevention strategies. Methods: All perioperative cardiac arrests in children up to 18 years from induction of anesthesia to postanesthesia care unit discharge or ICU admission during noncardia...
31 CitationsSource
Cited By1
#1Gerrit Jansen (Bielefeld University)H-Index: 1
#2Linda Irmscher (Bielefeld University)H-Index: 1
Last. Sebastian W. Rehberg (Bielefeld University)H-Index: 1
view all 7 authors...
STUDY OBJECTIVE To determine 30-day-mortality, incidence and characteristics of perioperative cardiac arrest as well as the respective independent risk factors in preterm infants undergoing non-cardiac surgery. DESIGN Retrospective observational Follow-up-study. SETTING Bielefeld University Hospital, a German tertiary care hospital. PATIENTS Population of 229 preterm infants (age 2000 g), and time of surgery (OR,5.9;95%CI,1.6 to 21.3) for 22:01-7:00 compared to 7:01-15:00) were the major indepen...