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Anesthesia-related cardiac arrest in children: update from the Pediatric Perioperative Cardiac Arrest Registry
Sanjay M Bhananker1, Chandra Ramamoorthy, Jeremy M Geiduschek
1Department of Anesthesiology, University of Washington School of Medicine, Seattle, WA, USA.
Insights
Pediatric anesthesia practices have shifted, reducing medication-related cardiac arrests. Cardiovascular and respiratory events are now more common causes of cardiac arrest in children during surgery.
Area of Science:
- Pediatric Anesthesiology
- Critical Care Medicine
- Patient Safety
Background:
- Previous Pediatric Perioperative Cardiac Arrest (POCA) Registry data (1994-1997) identified medication-related causes, particularly halothane-induced cardiovascular depression, as primary drivers of cardiac arrest in anesthetized children.
- Evolving pediatric anesthesia practices may have influenced the incidence and nature of perioperative cardiac arrests in pediatric patients.
Purpose of the Study:
- To analyze the causes and contributing factors of anesthesia-related cardiac arrests in children from 1998 to 2004.
- To compare these findings with earlier data from the POCA Registry (1994-1997) to identify trends in pediatric perioperative cardiac arrest causes.
Main Methods:
- Data collected from nearly 80 North American institutions participating in the Pediatric Perioperative Cardiac Arrest Registry.
- Anonymous submission of standardized data forms for all perioperative cardiac arrests in patients aged 18 years or younger.
- Analysis of anesthesia-related cardiac arrests and associated factors during the 1998-2004 study period.
Main Results:
- Anesthesia-related cardiac arrests constituted 49% of all arrests, with medication-related causes decreasing significantly to 18% (vs. 37% in 1994-1997).
- Cardiovascular causes (41%) were most frequent, primarily due to hypovolemia and hyperkalemia; respiratory causes (27%), mainly laryngospasm, were also significant.
- Vascular injury during central venous catheter placement was the leading equipment-related cause. Arrest causes varied by anesthesia care phase.
Conclusions:
- The observed reduction in medication-related arrests may correlate with decreased halothane use in pediatric anesthesia.
- Cardiovascular and respiratory events represent key areas for targeted preventive strategies to further reduce pediatric perioperative cardiac arrests.
- Ongoing surveillance and practice adaptation are crucial for enhancing patient safety in pediatric anesthesia.
Background:
The initial findings from the Pediatric Perioperative Cardiac Arrest (POCA) Registry (1994-1997) revealed that medication-related causes, often cardiovascular depression from halothane, were the most common. Changes in pediatric anesthesia practice may have altered the causes of cardiac arrest in anesthetized children.
Methods:
Nearly 80 North American institutions that provide anesthesia for children voluntarily enrolled in the Pediatric Perioperative Cardiac Arrest Registry. A standardized data form for each perioperative cardiac arrest in children
Results:
From 1998 to 2004, 193 arrests (49%) were related to anesthesia. Medication-related arrests accounted for 18% of all arrests, compared with 37% from 1994 to 1997 (P < 0.05). Cardiovascular causes of cardiac arrest were the most common (41% of all arrests), with hypovolemia from blood loss and hyperkalemia from transfusion of stored blood the most common identifiable cardiovascular causes. Among respiratory causes of arrest (27%), airway obstruction from laryngospasm was the most common cause. Vascular injury incurred during placement of central venous catheters was the most common equipment-related cause of arrest. The cause of arrest varied by phase of anesthesia care (P < 0.01). Cardiovascular and respiratory causes occurred most commonly in the surgical and postsurgical phases, respectively.
Conclusions:
A reduction in the proportion of arrests related to cardiovascular depression due to halothane may be related to the declining use of halothane in pediatric anesthetic practice. The incidence of the most common remaining causes of arrest in each category may be reduced through preventive measures.
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