Key result
Pediatric noncardiac perioperative cardiac arrest survival varies widely, with worse outcomes in younger, higher-risk patients.
Why the study?
Studies on pediatric perioperative cardiac arrest are heterogeneous with modest sample sizes and variable outcome reporting, leaving large knowledge gaps in management and long-term outcomes.
Systematic Review
Perioperative cardiac arrest in pediatric noncardiac surgery has a variable but potentially high survival rate (30% to 91%), though severe knowledge gaps remain regarding intra-arrest management, resuscitation quality, and long-term neurofunctional outcomes.
Variable survival after pediatric perioperative arrest warrants vigilance in young high-ASA patients; leaves open major gaps in resuscitation quality and long-term neurofunctional outcomes.
Introduction: The primary 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. Inclusion and exclusion criteria were defined a priori. We included studies in children (age <18 years) undergoing noncardiac surgery, experiencing 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 criteria. There were 17 retrospective cohort studies, 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% to 91% overall, with survival of 46% in the U.S.-based study. Younger age, higher American Society of Anesthesiologists score, and emergent procedures were associated with higher CA event occurrence. No study reported data on CA management, including quality of resuscitation, medication use, or defibrillation use. 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. Conclusion: Studies on pediatric perioperative CA are heterogenous, with modest sample sizes, and variability in definitions and reporting of outcomes. A large knowledge gap remains in CA management, neurologic consequences, and long-term outcomes.
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Nadkarni et al. (2026) conducted a systematic review in Pediatric perioperative cardiac arrest during noncardiac surgery. Perioperative cardiac arrest was evaluated on Survival, neurofunctional outcomes, quality of life, or healthcare utilization. In children undergoing noncardiac surgery, perioperative cardiac arrest survival to hospital discharge ranged from 30% to 91%, with younger age and higher ASA scores identified as risk factors.
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