Paediatric perioperative cardiac arrest and its mortality: database of a 60-month period from a tertiary care paediatric centre

Abstract

The analysis of perioperative cardiac arrest and mortality remains a potentially valuable method to improve clinical outcome. This survey evaluated the incidence and causes of perioperative cardiac arrests and mortality in a paediatric surgical population over 5 years. All cardiac arrests that occurred between April 2003 and March 2008, during administration of anaesthesia at the paediatric centre of our institute, were recorded from an anaesthesia database and postsurgical ICU census register. All surgery performed under anaesthesia was included whether emergency or elective. All surgical procedures were covered except eye surgery, cardiac surgery and the procedures performed at remote locations. Data collected included patient characteristics, surgical procedures, preoperative physical status and anaesthesia-provider information, immediate cause of cardiac arrest, antecedent events, management and outcome. All cardiac arrests were grouped according to the cause of arrest into one of four groups: totally anaesthesia related, partially anaesthesia related, surgery related or child condition related. There were a total of 27 cardiac arrests out of 12 158 procedures. Major risk factors for cardiac arrests were children under 1 year of age (P < 0.05), ASA physical status (ASA-PS) III or more (P < 0.001) and emergency surgery (P < 0.01). There were nine cardiac arrests attributed to anaesthesia, three totally and six partially related to anaesthesia. The main causes of anaesthesia-related cardiac arrest were respiratory events (56%), followed by cardiac events (33%). Anaesthesia-related mortality was 1.2/10 000 anaesthetics in patients with ASA-PS I-II and 7.7/10 000 anaesthetics in patients with ASA-PS III-V with a survival rate of 56%. Major risk factors for cardiac arrests were age under 1 year, poor physical status and emergency surgery. Respiratory and cardiovascular-related events accounted for most of all anaesthesia-related cardiac arrests. High ASA-PS was the leading cause of perioperative mortality.