Key result
Pediatric intraoperative cardiac arrest carries ~40% in-hospital mortality, driven by trauma and pulselessness.
Why the study?
Intraoperative cardiac arrest is a rare but high-risk event in the pediatric operating room, prompting evaluation of patient characteristics and mortality risk factors during non-cardiac surgery.
Pediatric intraoperative cardiac arrest during non-cardiac surgery has a 40% in-hospital mortality rate, with trauma and pulselessness identified as significant risk factors for death.
Informs family counseling on prognosis after pediatric non-cardiac intraoperative arrest; hypothesis-generating for strategies to mitigate trauma-associated mortality.
Introduction: Intraoperative cardiac arrest (CA) is a rare but high-risk event in the pediatric operating room. The aim of this study was to determine characteristics of children who experience CA during non-cardiac surgery and examine risk factors for mortality after these events. Methods: We conducted a retrospective multicenter cohort study using the American Heart Association Get With the Guidelines-Resuscitation registry to identify children (< 18 years) who experienced CA in the operating room during non-cardiac surgery between 2000 and 2023. Descriptive statistics were used to characterize the data. Univariate analysis is reported with odds ratios (ORs) and 95% confidence intervals (CIs). Results: A total of 804 intraoperative CA events were included, of which 321 (40%) resulted in in-hospital mortality. The median age was 24 months (interquartile range, 6 months-11 years). In univariate logistic regression analysis of age categories and mortality, neonates (< 1 month), infants (1 month to < 1 year), and children (1-12 years) had significantly lower odds of mortality compared to adolescents (>12 years): OR 0.53 (95% CI 0.29-0.97), OR 0.17 (95% CI 0.11-0.27), OR 0.37 (95% CI 0.25-0.53), respectively. Among illness categories, trauma was associated with significantly increased odds of mortality compared to other noncardiac surgical patients (OR 10.82, 95% CI 6.81-17.84). Those who were pulseless on initiation of cardiopulmonary resuscitation or who started with a pulse but progressed to pulselessness had significantly increased odds of mortality compared to those who were never pulseless (OR 7.68, 95% CI 5.32-11.29 and OR 4.92, 95% CI 2.96-8.23, respectively). Use of extracorporeal cardiopulmonary resuscitation was not significantly associated with mortality (OR 1.57, 95% CI 0.76-3.32). Each subsequent year included in the analysis was associated with a 4% reduction in odds of mortality (OR 0.96, 95% CI 0.93-0.98). Conclusions: In-hospital mortality following pediatric intraoperative CA in this registry study was 40%, lower than general in-hospital CA in children. Younger age was associated with decreased odds of in-hospital mortality, while trauma and pulselessness were associated with higher odds of mortality. Further analysis is needed to better understand potential contributors to these findings.
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Nadkarni et al. (2026) studied this question. Pediatric intraoperative cardiac arrest during non-cardiac surgery resulted in 40% in-hospital mortality, with trauma (OR 10.82) and pulselessness (OR 7.68) significantly increasing mortality risk.
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