Global mortality of children after perioperative cardiac arrest: A systematic review, meta-analysis, and meta-regression

Abstract

Background: The body of evidence showed that perioperative cardiac arrest and mortality trends varied globally over time particularly in low and middle-income nations. However, the survival of children after cardiac arrest and its independent predictors are still uncertain and a topic of debate. This study was designed to investigate the mortality of children after a perioperative cardiac arrest based on a systematic review of published peer-reviewed literature.

Methods: A comprehensive search was conducted in PubMed/Medline; Science direct, CINHAL, and LILACS from December 2000 to August 2021. All observational studies reporting the rate of perioperative CA among children were included. The data were extracted with two independent authors in a customized format. The methodological quality of the included studies was evaluated using the Newcastle-Ottawa appraisal tool.

Results: A total of 397 articles were identified from different databases. Thirty-eight studies with 3.35 million participants were included. The meta-analysis revealed that the global incidence of perioperative cardiac arrest was 2.54(95% CI: 2.23 to 2.84) per 1000 anesthetics. The global incidence of perioperative mortality was 41.18 (95% CI: 35.68 to 46.68) per 1000 anesthetics.

Conclusion: The incidence of anesthesia-related pediatric cardiac arrest and mortality is persistently high in the last twenty years in low and middle-income countries. This probes an investment in continuous medical education of the perioperative staff and adhering with the international standard operating protocols for common procedures and critical situations.

Registration: This systematic review and meta-analysis is registered in the research registry (UIN: researchregistry6932).

Keywords: Anesthesia-related; Cardiac arrest; Incidence; Mortality.

Fig. 1

Prisma flow chart.

Fig. 2

Forest plot for the global incidence of perioperative Mortality among children per 1000 anesthetics: The midpoint of each line illustrates the rate; the horizontal line indicates the confidence interval, and the diamond shows the pooled incidence of mortality.

Fig. 3

Forest plot for subgroup analysis of the global incidence of perioperative Mortality among children by countries economic level per 1000 anesthetics. The midpoint of each line illustrates the rate; the horizontal line indicates the confidence interval, and the diamond shows the pooled incidence of mortality.

Fig. 4

Forest plot for the incidence of anesthesia-related cardiac arrest among children per 1000 anesthetics: The midpoint of each line illustrates the rate; the horizontal line indicates the confidence interval, and the diamond shows the pooled incidence of anesthesia related-cardiac arrest.

Fig. 5

Forest plot for the incidence of anesthesia-related mortality among children per 1000 anesthetics: The midpoint of each line illustrates the rate; the horizontal line indicates the confidence interval, and the diamond shows the pooled incidence of mortality.

Fig. 6

Bubble plot for meta-regression analysis: A: perioperative cardiac arrest; B: perioperative mortality; C: Anesthesia-related cardiac arrest; D: Anesthesia-related mortality; E: Anesthesia-related mortality and F: cardiac arrest with medication error.

Fig. 7

Forest plot for factor analysis for acute myocardial injury among patients with COVID-19: The midpoint of each line illustrates the prevalence; the horizontal line indicates the confidence interval, and the diamond shows the pooled odds ratio.

Fig. 8

Contour-enhanced funnel plot and trim fill to assess publication bias. The vertical line indicates the effect size whereas the diagonal line indicates the precision of individual studies with a 95% confidence interval.