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Intraoperative Cardiopulmonary Arrest in Children Undergoing Spinal Deformity Correction: Causes and Associated
Emmanuel N Menga1, Cole Hirschfeld, Amit Jain
1*Department of Orthopaedic Surgery, The Johns Hopkins University, Baltimore, MD†Department of Anesthesiology, The Johns Hopkins University, Baltimore, MD‡Department of Orthopaedic Surgery, Texas Scottish Rite Hospital for Children, Dallas, TX.
Insights
Intraoperative cardiopulmonary arrest (ICA) occurred in 0.4% of pediatric spinal deformity surgeries. Patients with neuromuscular disorders faced a threefold higher risk of ICA, highlighting a critical risk factor.
Area of Science:
- Pediatric Surgery
- Orthopedic Surgery
- Cardiology
Background:
- Spinal deformities in children present significant surgical risks due to associated comorbidities.
- Intraoperative cardiopulmonary arrest (ICA) is a rare but serious complication in pediatric spinal surgery.
Purpose of the Study:
- To determine the incidence of intraoperative cardiopulmonary arrest (ICA) in children undergoing spinal deformity surgery.
- To identify risk factors associated with ICA in this patient population.
Main Methods:
- Retrospective review of patient records from two pediatric tertiary-care hospitals (2004-2014).
- Statistical analysis (Fisher exact test, Student t test) to compare ICA and non-ICA groups.
- Classification of proximate causes of ICA based on physiological and laboratory data.
Main Results:
- The incidence of ICA was 0.4% (11 of 2524 patients).
- Patients with neuromuscular disorders had a threefold increased risk of ICA.
- Significant differences observed in vertebral levels fused, patient weight, estimated blood loss, and proportion of blood volume lost between groups.
- Common causes included cardiovascular events, anaphylaxis, and primary rhythm disturbances.
Conclusions:
- Intraoperative cardiopulmonary arrest (ICA) occurs in approximately 0.4% of pediatric spinal fusion surgeries.
- Neuromuscular disorders are a significant risk factor for ICA in children undergoing spinal deformity surgery.
Study Design:
Retrospective review.
Objective:
To report the incidence of and risk factors for intraoperative cardiopulmonary arrest (ICA) in children undergoing spinal deformity surgery.
Summary Of Background Data:
Spinal deformities in children are associated with comorbidities that can pose substantial risks during surgery.
Methods:
We reviewed records of patients who underwent surgery at two pediatric tertiary-care hospitals from 2004 through 2014. Fisher exact test and the Student t test were used to compare ICA and non-ICA groups by patient diagnosis, estimated blood loss, number of vertebral levels fused, and proportion of blood volume lost (significance, P < 0.05). We classified proximate causes of ICA based on hemoglobin, metabolic panel/electrolyte imbalance, electrocardiogram/echocardiography, and vital signs.
Results:
ICA occurred in 11 of 2524 (0.4%) patients. Patients with neuromuscular disorders had a 3-fold higher risk of ICA compared with those without neuromuscular disorders. At the time of ICA, hemoglobin levels were 5 g/dL or less in four patients, potassium was higher than 5.5 mEq/L in six patients, and ionized calcium was less than or equal to 1 mmol/L in two patients. There were significant differences between the ICA and non-ICA groups in mean number of vertebral levels fused (15 vs. 12), patient weight (34 vs. 49 kg), estimated blood loss (2623 vs. 959 mL), and proportion of blood volume lost (1.03 vs. 0.33) (all P < 0.01). Suspected causes of ICA were cardiovascular causes (eight patients) and anaphylaxis, primary rhythm disturbance, and respiratory/airway cause (one patient each). The incidence of ICA for patients with idiopathic scoliosis was 0.13%. Ten of the 11 patients were successfully resuscitated, and one patient died.
Conclusion:
ICA occurs in approximately 0.4% of children undergoing spinal fusion surgery. Patients with neuromuscular disorders are at greater risk of ICA than those without these disorders.
Level Of Evidence:
3.
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