Anesthesia-related cardiac arrest in children

Background: The Pediatric Perioperative Cardiac Arrest (POCA) Registry mas formed in 1994 in an attempt to determine the clinical factors and outcomes associated with cardiac arrest in anesthetized children. Methods: Institutions that provide anesthesia for children are voluntarily enrolled in the POCA Registry. A representative from each institution provi des annual institutional demographic information and submits anonymously a standardized data form for each cardiac arrest (defined as the need for che st compressions or as death) in. anesthetized children 18 yr of age or youn ger. Causes and factors associated with cardiac arrest are analyzed. Results: In the first 4 yr of the POCA Registry, 63 institutions enrolled a nd submitted 289 cases of cardiac arrest. Of these, 150 arrests were judged to be related to anesthesia. Cardiac arrest related to anesthesia had an i ncidence of 1.4 +/- 0.45 (mean +/- SD) per 10,000 instances of anesthesia a nd a mortality rate of 26%, Medication-related (37%) and cardiovascular (32 %) causes of cardiac arrest were most common, together accounting for 69% o f ail arrests. Cardiovascular depression from halothane, alone or in combin ation with other drugs, was responsible for two thirds of all medication-re lated arrests. Thirty-three percent of the patients were American Society o f Anesthesiologists physical status 1-2; in this group, 64% of arrests were medication-related, compared with 23% in American Society of Anesthesiolog ists physical status 3-5 patients (P < 0.01). Infants younger than 1 yr of age accounted for 55% of all anesthesia-related arrests. Multivariate analy sis demonstrated two predictors of mortality: American Society of Anesthesi ologists physical status 3-5 (odds ratio, 12.99; 95% confidence interval 2. 9-57.7), and emergency status (odds ratio, 3.88; 95% confidence interval 1. 6-9.6). Conclusions: Anesthesia-related cardiac arrest occurred most often in patie nts younger than 1 yr of age and in patients with severe underlying disease . Patients in the latter group, as well as patients having emergency surger y, were most Likely to have a fatal outcome. The identification of medicati on-related problems as the most frequent cause of anesthesia-related cardia c arrest has important implications for preventive strategies.