Training anesthesiologists to manage perioperative cardiac arrest in children: a scoping review

Education on appropriate management of pediatric cardiac arrest (CA) constitutes an essential part of training for anesthesiologists and the perioperative medical team. The aim of this scoping review was to synthesize the literature on educational, training, and quality improvement strategies for management of pediatric perioperative CA during noncardiac surgery procedures as they relate to improving clinical outcomes for children (Key Question 1 [KQ1]) and improving outcomes related to provider knowledge, performance, and confidence in CA management (Key Question 2 [KQ2]). We conducted electronic searches of PubMed, Embase, and Scopus in February 2024, with an update in June 2025. Bibliographies of relevant articles were hand searched. For KQ1, we included studies in children (< 18 years) undergoing noncardiac surgery, in which anesthesia providers underwent education, curriculum training, or quality improvement interventions on intraoperative CA, and at least on pre-defined incidence or survival outcome was ascertained. For KQ2, we included studies in which anesthesia providers or multidisciplinary anesthesia teams underwent education, curriculum training, or quality improvement interventions on intraoperative CA, with at least one provider knowledge, skills, or confidence level outcome ascertained. Two authors reviewed citations independently with a third author solving conflicts. Of 689 unique citations found via electronic search and 4 additional citations found via manual search, no studies met inclusion criteria for patient-based outcomes (KQ1), and one study met inclusion criteria for provider-based outcomes (KQ2). The included study used a survey design to assess knowledge among anesthesia providers of the 2005 American Heart Association Pediatric Advanced Life Support recommendations and demonstrated that those who underwent certification courses within the past 2 years had a greater percentage of correct answers to resuscitation questions. Pediatric anesthesia subspecialty training was not associated with correct answers. This scoping review demonstrates the striking lack of studies published on educational, training, and quality improvement strategies to improve clinical and provider outcomes in preventing and treating pediatric perioperative CA. This represents a high priority gap in perioperative education. Further research is essential to the development of consistent evidence-based approaches to training anesthesia providers and teams.