Pediatric perioperative cardiac arrest during noncardiac surgery has a 30-91% hospital survival rate, with higher risk linked to younger age, higher ASA scores, and emergent procedures.
A scoping review highlights significant knowledge gaps in the management, neurologic consequences, and long-term outcomes of pediatric perioperative cardiac arrest during noncardiac surgery.
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Introduction: Pediatric perioperative cardiac arrest (CA) continues to occur and represents a critical point of failure with potentially fatal consequences. The goal of this scoping review was to create a comprehensive synthesis of the characteristics, management, and outcomes of perioperative CA events in children undergoing noncardiac surgery. Methods: We conducted electronic searches of PubMed, Embase and Scopus in February 2024, with an update in June 2025. We included studies in children (< 18 years) undergoing noncardiac surgery, experiencing perioperative CA (while under the care of anesthesia personnel or in immediate postoperative phases), with at least one pre-defined survival, neurofunctional, quality of life, or healthcare utilization outcome ascertained. Two authors reviewed citations independently with a third author solving conflicts. Results: Of 801 unique citations, 18 studies met inclusion/exclusion criteria. There were 17 retrospective cohorts, 1 cross sectional study, and no interventional studies. Median number of CA events per study was 21 (interquartile range, 13-27). Survival to hospital discharge ranged from 30-91% overall, with a range of 46-68% in U.S.-based studies. Younger age, higher American Society of Anesthesiologists score, and emergent procedures were associated with higher CA rates. CA events designated as anesthesia-related had a trend towards higher hospital survival compared to overall perioperative CA events. One study noted an association between CA duration and mortality after CA. No study reported data on CA management, including quality of resuscitation, medication use, or defibrillation. No studies obtained neurofunctional outcomes using standardized measures. No studies addressed long-term survival, neurofunctional, healthcare utilization, or quality of life outcomes after hospital discharge. Conclusions: Studies of pediatric perioperative CA are heterogenous, with modest sample sizes, and variability in definitions and outcome reporting. A large knowledge gap remains in CA management, neurologic consequences, and long-term outcomes. Further research is essential to establish a more comprehensive understanding of and potential interventions to improve outcomes of perioperative CA in children undergoing noncardiac surgery.
Nadkarni et al. (Sun,) reported a other. Pediatric perioperative cardiac arrest during noncardiac surgery has a 30-91% hospital survival rate, with higher risk linked to younger age, higher ASA scores, and emergent procedures.