Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2023 Dec 3:8:100244.
doi: 10.1016/j.bjao.2023.100244. eCollection 2023 Dec.

Predictors and outcomes of perioperative cardiac arrest in children undergoing noncardiac surgery

Carine Foz  1 , Steven J Staffa  1 , Morgan L Brown  1 , James A DiNardo  1 , Viviane G Nasr  1
Affiliations

Predictors and outcomes of perioperative cardiac arrest in children undergoing noncardiac surgery

Carine Foz et al. BJA Open. .

Abstract

Background: Perioperative cardiac arrest continues to occur. This study aims to identify risk factors for perioperative cardiac arrest in children presenting for noncardiac surgery and characterise its outcomes.

Methods: Using the National Surgical Quality Improvement Program (NSQIP) Pediatric Database 2019 and 2020, 261 276 patients were included. Patients ≥18 yr and cardiac surgical procedures were excluded. Exploratory multivariable analysis was performed to identify independent predictors of perioperative cardiac arrest and associated outcomes.

Results: The overall rate of cardiac arrest was 0.1%, with an intraoperative rate of 0.05% and 48-h postoperative rate of 0.06%. Significant risk factors for perioperative cardiac arrest included age <12 months (adjusted odds ratios [aOR] 3.07, P<0.001), American Society of Anesthesiology Physical Status classification (ASA-PS 3 aOR=2.57, P<0.001; ASA-PS 4 aOR=5.27, P<0.001; ASA-PS 5 aOR=13.1, P<0.001), admission through the emergency room (aOR 1.7, P=0.003), inpatient (aOR 2.19, P=0.008), major and severe cardiac disease (aOR 1.58, P=0.008), impaired cognitive status (aOR 1.54, P=0.009), and longer anaesthesia duration (aOR 1.1 per 30 min, P<0.001). Perioperative cardiac arrest was significantly associated with longer hospital length of stay, reoperation, differences in discharge destination, and 30-day mortality. In addition, patients experiencing postoperative cardiac arrest had a significantly higher rate of in-hospital and 30-day mortality than those experiencing intraoperative cardiac arrest.

Conclusions: The incidence of cardiac arrest in this study is higher than previously reported. This may be related to selection bias and the rigorous data collection required by NSQIP. Lower 30-day mortality after intraoperative cardiac arrest could be related to prompt recognition and rapid initiation of intraoperative resuscitation. Identification of perioperative risk factors for cardiac arrest is crucial to improve the safety and quality of patient care.

Keywords: 30-day mortality; outcomes; paediatric patients; perioperative cardiac arrest; risk factors.

PubMed Disclaimer

References

    1. Olsson G.L., Hallen B. Cardiac arrest during anaesthesia. A computer-aided study in 250,543 anaesthetics. Acta Anaesthesiol Scand. 1988;32:653–664. - PubMed
    1. Tiret L., Nivoche Y., Hatton F., Desmonts J.M., Vourc'h G. Complications related to anaesthesia in infants and children. A prospective survey of 40240 anaesthetics. Br J Anaesth. 1988;61:263–269. - PubMed
    1. Gobbo Braz L., Braz J.R., Modolo N.S., do Nascimento P., Brushi B.A., Raquel de Carvalho L. Perioperative cardiac arrest and its mortality in children. A 9-year survey in a Brazilian tertiary teaching hospital. Paediatr Anaesth. 2006;16:860–866. - PubMed
    1. Cohen M.M.C.C., Duncan P.G. Pediatric anesthesia morbidity and mortality in the perioperative period. Anesth Analg. 1990;70:160–167. - PubMed
    1. Flick R.P., Sprung J., Harrison T.E., et al. Perioperative cardiac arrests in children between 1988 and 2005 at a tertiary referral center: a study of 92,881 patients. Anesthesiology. 2007;106:226–237. quiz 413–224. - PubMed

LinkOut - more resources