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Pediatric Perioperative Cardiac Arrest, Death in the Off Hours: A Report From Wake Up Safe, The Pediatric Quality
Robert E Christensen1, Angela C Lee2, Marie S Gowen3
1From the Department of Anesthesiology, University of Michigan, Ann Arbor, Michigan.
Insights
Pediatric perioperative cardiac arrest (CA) is rare but serious. This study found that while patient factors like age and health status influence CA, off-hours arrests significantly worsen outcomes, suggesting a need for improved care during these times.
Area of Science:
- Anesthesiology
- Pediatric Critical Care
- Patient Safety
Background:
- Pediatric perioperative cardiac arrest (CA) is a rare yet critical event during anesthesia.
- Understanding the incidence, causes, and outcomes of pediatric CA is crucial for improving patient safety.
- The Wake Up Safe initiative provides a valuable dataset for analyzing these events.
Purpose of the Study:
- To analyze the incidence, causes, and outcomes of pediatric perioperative cardiac arrest (CA).
- To identify factors associated with CA and mortality following arrest in pediatric patients.
- To explore strategies for enhancing outcomes in pediatric CA cases.
Main Methods:
- A case-control study utilizing data from the Wake Up Safe Pediatric Anesthesia Quality Improvement Initiative registry.
- Extraction of incidence, demographics, underlying conditions, causes of CA, and outcomes.
- Descriptive statistics and logistic regression were employed to analyze factors associated with CA and mortality.
Main Results:
- A total of 531 pediatric cardiac arrests (CAs) occurred among 1,006,685 anesthetics.
- Factors associated with CA included younger age (≥6 vs <6 months), higher American Society of Anesthesiologists physical status (ASA PS III-V), and emergency surgery.
- Increased mortality was linked to higher ASA PS and emergency status, while anesthesia-related arrests showed lower mortality. Off-hours arrests (nights/weekends) were independently associated with worse outcomes.
Conclusions:
- Findings from the Wake Up Safe registry confirm previous single-institution study results on pediatric perioperative CA.
- Perioperative CA occurring during off-hours (nights/weekends) is associated with significantly worse outcomes, irrespective of patient physical status or surgical urgency.
- Targeted interventions and improved resource allocation during off-hours may present an opportunity to enhance outcomes for pediatric patients experiencing CA.
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 strategies for improving outcomes are considered.
Methods:
CA in children was identified from the Wake Up Safe Pediatric Anesthesia Quality Improvement Initiative, a multicenter registry of adverse events in pediatric anesthesia. Incidence, demographics, underlying conditions, causes of CA, and outcomes were extracted. Descriptive statistics and logistic regression were used to study the above factors associated with CA and mortality after CA.
Results:
A total of 531 cases of CA occurred during 1,006,685 anesthetics. CA was associated with age (odds ratio [95% confidence interval] comparing ≥6 vs <6 months of 0.26 [0.22-0.32]; P = .014), American Society of Anesthesiologists physical status (ASA PS III-V versus I-II, 9.24, 7.23-11.8; P < .001), and emergency status (3.55, 2.88-4.37; P < .001). Higher ASA PS was associated with increased mortality (ASA PS III-V versus I-II, 3.25, 1.20-8.81; P = .02) but anesthesia-related arrests were correlated with lower mortality (0.44, 0.26-0.74; P = .002). ASA emergency status (1.83, 1.05-3.19; P = .03) and off hours (night and weekend versus weekday, 2.17, 1.22-3.86; P = .008) were other factors associated with mortality after CA.
Conclusions:
The Wake Up Safe data validate single-institution studies' findings regarding incidence, factors associated with arrest, and outcomes of pediatric perioperative CA. However, CA occurring during the off hours had significantly worse outcomes, independent of patient physical status or emergency surgery. This suggests an opportunity for improved outcomes.
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