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[Anesthesia-related cardiac arrest in children. Data from a tertiary referral hospital registry]
P Sanabria-Carretero1, C Ochoa-Osorio, A Martín-Vega
1Servicios de Anestesia, Cuidados Críticos Quirúrgicos y Tratamiento del Dolor en Pediatría, Hospital Infantil Universitario La Paz, Madrid, España.
Insights
Anesthesia-related cardiac arrests in children are rare but serious. Key risk factors include severe patient conditions (ASA III+), young age, and specific procedures, with hypovolemia being a primary cause.
Area of Science:
- Pediatric Anesthesiology
- Critical Care Medicine
- Cardiovascular Research
Context:
- Anesthesia-related cardiac arrest (ARCA) in pediatric patients is a critical event.
- Tertiary children's hospitals manage complex pediatric cases.
- Understanding ARCA risk factors is vital for patient safety.
Purpose:
- To analyze anesthesia-related cardiac arrests in a pediatric tertiary care setting.
- To identify significant risk factors associated with ARCA and mortality.
- To inform strategies for improving patient outcomes during anesthesia.
Summary:
- A 5-year retrospective study identified 15 anesthesia-related cardiac arrests in 43,391 pediatric procedures.
- Major risk factors included American Society of Anesthesiologists (ASA) physical status III or higher, age under one year, emergency status, cardiac procedures, and catheterization lab settings.
- Cardiovascular causes, primarily hypovolemia, were the leading cause of arrest, followed by respiratory and medication-related events.
Impact:
- Identified high-risk patient groups (ASA III+, infants) and procedures (cardiac, catheterization lab) for targeted interventions.
- Highlighted hypovolemia as a critical, potentially modifiable cause of pediatric ARCA.
- Findings underscore the need for enhanced vigilance and tailored anesthetic management in high-risk pediatric populations.
Objectives:
The aim of this study is to analyze the cardiac arrests related to anesthesia in a tertiary children's hospital, in order to identify risk factors that would lead to opportunities for improvement.
Methods:
A 5-year retrospective study was conducted on anesthesia related cardiac arrest occurring in pediatric patients. All urgent and elective anesthetic procedures performed by anesthesiologists were included. Data collected included patient characteristics, the procedure, the probable cause, and outcome of the cardiac arrest. Odds ratio was calculated by univariate analysis to determine the clinical factors associated with cardiac arrest and mortality.
Results:
There were a total of 15 cardiac arrests related to anesthesia in 43,391 anesthetic procedures (3.4 per 10,000), with an incidence in children with ASA I-II versus ASA≥III of 0.28 and 19.27 per 10,000, respectively. The main risk factors were children ASA≥III (P<.001), less than one month old (P<.001), less than one year old (P<.001), emergency procedures (P<.01), cardiac procedures (P<.001) and procedures performed in the catheterization laboratory (P<.05). The main causes of cardiac arrest were cardiovascular (53.3%), mainly due to hypovolemia, and cardiovascular depression associated with induction of anesthesia, followed by respiratory causes (20%), and medication causes (20%). The incidence of mortality and neurological injury within the first 24h after the cardiac arrest was 0.92 and 1.38 per 10,000, respectively. The mortality in the first 3 months was 1.6 per 10,000. The main causes of death were ASA≥III, age under one year, pulmonary arterial hypertension, cardiac arrest in areas remote from the surgery area, a duration of cardiopulmonary resuscitation over 20min, and when hypothermia was not applied after cardiac arrest.
Conclusion:
The main risk factors for cardiac arrest were ASA≥III, age under one year, emergency procedures, cardiology procedures and procedures performed in the catheterization laboratory. The main cause of the cardiac arrest was due mainly to cardiovascular hypovolemia. All patients who died or had neurological injury were ASA≥III. Pulmonary arterial hypertension is a risk of anesthesia-related mortality.
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