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Global anaesthesia-related cardiac arrest rates in children: a systematic review and meta-analysis

Teofilo Augusto A Tiradentes1, Sharon Einav2, Jose R C Braz1

  • 1Anaesthesia Cardiac Arrest and Mortality Study Commission, Department of Surgical Specialties and Anaesthesiology, Botucatu Medical School, Sao Paulo State University - UNESP, Botucatu, Sao Paulo, Brazil.

British Journal of Anaesthesia
|September 24, 2023
PubMed

Insights

Anesthesia-related cardiac arrest rates in children are higher in low Human Development Index (HDI) countries. Infants under one year old face the highest risk, indicating a persistent global challenge in pediatric anesthesia safety.

Area of Science:

  • Pediatric Anesthesiology
  • Global Health
  • Developmental Pediatrics

Background:

  • Neonates and infants face increased perioperative risks compared to adults.
  • Previous studies linked anesthesia safety to a country's Human Development Index (HDI).
  • This study investigates anesthesia-related cardiac arrest rates (ARCAR) in children concerning country HDI and time.

Purpose of the Study:

  • To examine the relationship between anesthesia-related cardiac arrest rates (ARCAR) in children and country Human Development Index (HDI).
  • To analyze trends in ARCAR over time and across different HDI levels.
  • To identify specific pediatric age groups at higher risk for anesthesia-related cardiac arrest.

Main Methods:

  • Systematic review and meta-analysis of electronic databases up to July 2022.
  • Analysis of 24-h postoperative ARCARs per 10,000 anesthetic procedures.
  • Comparison of ARCARs in low-HDI (HDI<0.8) vs. high-HDI (HDI≥0.8) countries and across time periods (pre-2001 vs. 2001-22).

Main Results:

  • 38 studies including 5,493,489 anesthetic procedures and 1001 ARCARs were analyzed.
  • ARCARs showed an inverse correlation with country HDI (P<0.0001) but no correlation with time (P=0.82).
  • In 2001-22, ARCARs were significantly higher in low-HDI countries (9.6) than high-HDI countries (2.0).
  • Children under 1 year had substantially higher ARCARs than those 1 year or older in both high-HDI (OR 8.03) and low-HDI countries (OR 7.32).

Conclusions:

  • Anesthesia-related cardiac arrest rates in children remain a significant global concern.
  • The disparity in ARCARs between low-HDI and high-HDI countries highlights global inequities in pediatric anesthesia care.
  • Infants under one year of age represent a particularly vulnerable population requiring focused attention to improve anesthesia safety.
Abstract

Keywords:
cardiac arrestchildrendeveloped countriesdeveloping countriessystematic review

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