Incidence of perioperative cardic arrest in children undergoing cardiac surgery at the Red Cross War Memorial Children's Hospital
Background: Perioperative cardiac arrest in children under anaesthesia remains a rare and often avoidable event. Current data reports a decreasing trend in mortality following arrest in high-income countries, but a persistently high incidence of anaesthesia-related cardiac arrest and mortality in low and middle-income countries (LMICs). The objective of this study was twofold: to gain insight into the aetiology of perioperative cardiac arrest, and to establish a benchmark for the incidence of perioperative and anaesthesia-related cardiac arrest in children undergoing cardiac surgery at a high-volume centre in a LMIC. Method: Retrospective cohort study of all consecutive patients aged less than 16 years who underwent cardiac surgery over a period of 9 years (January 2012 to December 2020) at the Red Cross War Memorial Children's Hospital. The primary outcome was the incidence of perioperative cardiac arrest in children aged less than 16 years undergoing cardiac surgery. Secondary outcome was on table mortality. Results: The overall incidence of perioperative cardiac arrest was 121.1 per 10,000 anaesthetics and the overall incidence of anaesthesia-related cardiac arrest was 13.5 per 10,000. The most frequent timing of arrest was following separation from CPB (7/36, 19.4%). Four of thirty-six cardiac arrests (11.2%) occurred during induction of anaesthesia. A quarter of patients (9/36, 25.0%) who suffered a perioperative cardiac arrest died on table. Conclusion: This is the first study reporting on the incidence and epidemiology of perioperative and anaesthesia-related cardiac arrest in children undergoing cardiac surgery in a high-volume centre in a LMIC. Important findings are the similar incidence of cardiac arrest during paediatric cardiac surgery in comparison to a high-income setting, and a high mortality rate associated with cardiac arrest. Early identification and optimisation of children with complex cardiac lesion is key. From the time the patient has been identified as a candidate for cardiac surgery, there should be multidisciplinary input, which includes the anaesthesia team. Further studies are needed to advance insight into the aetiology of perioperative cardiac arrest in these patients and gain understanding into the longer-term outcomes following cardiac arrest.
Cardiac surgery, Children, Red Cross Memorial Children's Hospital
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Department of Anaesthesia and Perioperative Medicine