Pediatric Perioperative Cardiac Arrest and Mortality

OBJECTIVES: A previous survey performed in our institution demonstrated perioperative pediatric cardiac arrest and mortality rates of 22.9 and 9.8 per 10,000 anesthetics, respectively, and an anesthesia-related cardiac arrest rate of 4.58 per 10,000 anesthetics. Changes in pediatric practices (i.e., safer anesthesia techniques and change in population) may have altered cardiac arrest rates. The aim of this investigation was to reexamine the perioperative and anesthesia-related cardiac arrest rates, causes, and outcomes in a Brazilian institution. DESIGN: Observational study. SETTING: Tertiary teaching hospital. PATIENTS: Children less than 18 years old, who were administered an anesthetic between January 1, 2005, and December 31, 2010, were included in this study. The cardiac arrest cases were identified from an anesthesia database. The data included children's characteristics, surgical procedures, American Society of Anesthesiologists physical status classification, surgical areas, and surgery type. The outcomes were perioperative cardiac arrest and mortality and anesthesia-related (totally or partially) cardiac arrest and mortality. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: There were 10,649 anesthetics during the study period, with 22 perioperative cardiac arrests and 11 deaths (20.65 and 10.32 per 10,000 anesthetics, respectively). A high incidence of perioperative cardiac arrest occurred in American Society of Anesthesiologists IV-V neonates and infants who underwent emergency surgery. There were no perioperative cardiac arrests in children aged 13 through 17, no anesthesia-related cardiac arrest in American Society of Anesthesiologists I-III children, and no totally anesthesia-related cardiac arrest. The anesthesia-related cardiac arrest rate was 2.81 per 10,000 anesthetics, with no anesthesia-related mortality. Respiratory events accounted for all of the anesthesia-related cardiac arrests. CONCLUSIONS: Despite the improvements achieved in the pediatric anesthesia safety in our institution, the perioperative cardiac arrest rates are still high and similar to the developing countries rates, with the child's disease or condition being the most important trigger for cardiac arrest. Airway management continues to be the greatest cause of anesthesia-related cardiac arrest.