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Cardiac Arrest in Children

  • Pediatric Anesthesia (J Lerman, Section Editor)
  • Published:
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Abstract

Perioperative cardiac arrest in children is a rare but catastrophic adverse event. It is difficult to investigate the incidence, risk factors, causes, and outcomes from these events, but the exercise is extremely useful in order to develop strategies to prevent it. Recent data identified several major risk factors for cardiac arrest in children: American Society of Anesthesiologists (ASA) physical status >3, age <1 year, and lack of specific pediatric experience by the healthcare providers. Since 1994, when the Perioperative Cardiac Arrest (POCA) Registry was created, the frequency of medication-related causes of cardiac arrest in children has decreased while the frequency of respiratory and cardiovascular causes has increased. The International Liaison Committee on Resuscitation Consensus Conference adopted the “5H+5T” acronym for the reversible causes of pediatric cardiac arrest: hypoxia, hypovolemia, hyper/hypokalemia, hypothermia, tension pneumothorax, cardiac tamponade, toxins, and cardiopulmonary thromboembolism. In this review article, the pathophysiology, diagnostic pathway, and treatment of perioperative cardiac arrest in children will be addressed. The importance of a certified training of anesthesiologists in pediatric advanced life support is also highlighted.

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References

Papers of particular interest, published recently, have been highlighted as: •• Of major importance

  1. Lee C, Mason L. Complications in paediatric anaesthesia. Curr Opin in Anaesth. 2006;19:262–7.

    Google Scholar 

  2. Beecher H, Todd D. A study of the deaths associated with anesthesia and surgery. Ann Surg. 1954;140:2–35.

    CAS  PubMed  PubMed Central  Google Scholar 

  3. Morray JP, Geiduschek JM, Caplan RA, et al. A comparison of pediatric and adult anesthesia closed malpractice claims. Anesthesiology. 1993;78:461–7.

    CAS  PubMed  Google Scholar 

  4. Morray JP, Geiduschek JM, Ramamoorthy C, et al. Anesthesia-related cardiac arrest in children: initial findings of the POCA Registry. Anesthesiology. 2000;93:6–14.

    CAS  PubMed  Google Scholar 

  5. Tiret L, Nivoche Y, Hatton F, et al. Complications related to anesthesia in infants and children: a prospective survey of 40240 anaesthetics. Br J Anaesth. 1988;61:263–9.

    CAS  PubMed  Google Scholar 

  6. Cohen MM, Cameron CB, Duncan PG. Pediatric anesthesia morbidity and mortality in the perioperative period. Anesth Analg. 1990;70:160–7.

    CAS  PubMed  Google Scholar 

  7. Tropjian AA, Berg RA, Nadkarni VM. Pediatric cardiopulmonary resuscitation: advanced in science, techniques, and outcomes. Pediatrics. 2008;122:1086–98.

    Google Scholar 

  8. Posner KL, Geiduschek J, Habernkern CM, et al. Unexpected cardiac arrest among children during surgery: a North American registry to elucidate the incidence and causes of anesthesia related cardiac arrest. Qual Saf Health Care. 2002;11:252–7.

    CAS  PubMed  Google Scholar 

  9. Zgleszewski SE, Graham D, Hickey PR, et al. Anesthesia-related cardiac arrest: five year analysis at an academic pediatric medical center. Anesthesiology. 2006:105–A134.

  10. Bunchungmongkol N, Somboonviboon W et al. Pediatric anesthesia adverse events: the Thai Anesthesia Incidents study database of 25, 098 cases. J.MedAssoc Thai 2007.

  11. Ji-Hyun L, Eun-Kyung K, In-Kyung S, et al. Critical incidents, including cardiac arrest, associated with pediatric anesthesia at a tertiary teaching children’s hospital. Pediatr Anesth. 2016;26:409–17.

    Google Scholar 

  12. Braz LG, Braz JRC, Pinheiro NS, et al. Perioperative cardiac arrest and its mortality in children. A 9-year survey in a Brazilian tertiary teaching hospital. Pediatr Anesth. 2006;16:860–6.

    Google Scholar 

  13. Bhananker SM, Ramamoorthy C, Geiduschek JM, et al. Anesthesia-related cardiac arrest in children: update from the pediatric perioperative cardiac arrest registry. Anesth Analg. 2007;105:344–50.

    PubMed  Google Scholar 

  14. Ramamoorthy C, Habernkern CM, Sanjay M, et al. Anesthesia-related cardiac arrest in children with heart disease: data from the pediatric perioperative cardiac arrest (POCA) Registry. Anesth Analg. 2010;110(5):1376–82.

    CAS  PubMed  Google Scholar 

  15. Odegart KC, Di Nardo JA, Kussman BD, et al. The frequency of anesthesia-related cardiac arrest in patients with congenital heart disease undergoing cardiac surgery. Anesth Analg. 2007;105:335–43.

    Google Scholar 

  16. Odegard KC, Bergensen L, Thiagarajan R, et al. The frequency of cardiac arrests in patients with congenital heart disease undergoing cardiac catheterization. Anesth Analg. 2014 Jan;118(1):175–82.

    PubMed  Google Scholar 

  17. Morray JP. Cardiac arrest in anesthetized children: recent advances and challenges for the future. Paediatr Anaesth. 2011;7:722–9.

    Google Scholar 

  18. •• De Caen AR, Berg D, et al. Part 12: pediatric advanced life support 2015 American Heart Association Guidelines update for cardiopulmonary resuscitation and emergency cardiovascular care. Circulation. 2015 Nov 3;132(18 Suppl 2):S526–42. These guidelines, updated every 5 years, are derive from the international consensus of expert on cardiopulmonary resuscitation.

  19. •• De Caen AR, Maconochie IK, Aickin R, et al. Part 6—2015 International Consensus on cardiopulmonary resuscitation and emergency cardiovascular care science with treatment recommendations. Circulation. 2015;132(suppl 1):S177–203. These recommendations, updated every 5 years, are derive from the international consensus of expert on cardiopulmonary resuscitation.

    PubMed  Google Scholar 

  20. Tropjian A, Nadkarni VM, Berg R. Cardiopulmonary resuscitation in children. Curr Opin in Critical Care. 2009;15:203–8.

    Google Scholar 

  21. Smith HM, Farrow SJ, Ackerman JD, Stubbs JR, Sprung J. Cardiac arrest associated with hyperkalemia during red blood transfusion: a case series. Anesth Analg. 2008;106:1062–9.

    PubMed  Google Scholar 

  22. Piotrowski AJ, Fendler WM. Hyperkalemia and cardiac arrest following succinylcholine administration in a 16-year-old boy with acute nonlymphoblastic leukemia and sepsis. Pediatr Crit Care Med. 2007;8(2):183–5.

    PubMed  Google Scholar 

  23. Gronert GA. Cardiac arrest after succinylcholine: mortality greater with rhabdomyolysis than receptor upregulation. Anesthesiology. 2001;94:523–9.

    CAS  PubMed  Google Scholar 

  24. Parham WA, Mehdirad AA, Biermann KM, et al. Hyperkalemia revisited. Texas heart Inst J. 2006;33:40–7.

    Google Scholar 

  25. Moncrief JA. Complications of burns. Ann Surg. 1958;147:443–75.

    CAS  PubMed  PubMed Central  Google Scholar 

  26. Tolmie JD, Joyce TH, Mitchell GD. Succinylcholine in the burned patient. Anesthesiology. 1967;28:467–70.

    CAS  PubMed  Google Scholar 

  27. Martyn JAJ, Richtsfeld M. Succinylcholine-induced hyperkalemia in acquired pathologic states. Anesthesiology. 2006;104:158–69.

    CAS  PubMed  Google Scholar 

  28. Thapa S, Brull SJ. Succinylcholine-induced hyperkalemia in patients with renal failure: an old question revisited. Anesth Analg. 2000;91:237–41.

    CAS  PubMed  Google Scholar 

  29. Dierdorf SF, McNiece WL, Rao CC, et al. Effect of succinylcholine on plasma potassium in children with cerebral palsy. Anesthesiology. 1985;62:88–90.

    CAS  PubMed  Google Scholar 

  30. McDonnell C, Barlow R, Campisi P, et al. Fatal peri-operative acute tumour lysis syndrome precipitated by dexamethasone. Anaesthesia. 2008;63:652–5.

    CAS  PubMed  Google Scholar 

  31. Chanimov M, Koren-Michowitz M, Cohen ML, et al. Tumor lysis syndrome induced by dexamethasone. Anesthesiology. 2006;105:633–4.

    PubMed  Google Scholar 

  32. Reinoso Barbero F, Sepulveda I, Perez-Ferrer A, De Andres A. Cardiac arrest secondary to hyperkalemia during surgery for a neonatal giant sacrococcygeal teratoma. Pediatr Anesth. 2009;19:695–715.

    Google Scholar 

  33. Polito A, Biasucci DG, Cogo P. Point of care pleural and lung ultrasound in a newborn suffering from cardiac arrest due to tension pneumothorax after cardiac surgery. Cardiolo Young. 2016;26(2):400–2.

    Google Scholar 

  34. Bar-Joseph G, Galvis AG. Perforation of the heart by central venous catheters in infants: guidelines to diagnosis and management. J Pediatr Surg. 1983;18:284–7.

    CAS  PubMed  Google Scholar 

  35. Leech RC, Watts AD, Heaton ND, et al. Intraoperative cardiac tamponade after central venous cannulation in an infant during orthotopic liver transplantation. Anesth Analg. 1999;89:342–3.

    CAS  PubMed  Google Scholar 

  36. Auden SM, Lapin SL, Reynolds AM. Cardiac arrest from tension pneumopericardium in a premature infant. Anesth Analg. 2002;95:1245–7.

    PubMed  Google Scholar 

  37. Lonnqvist PA. Toxicity of local anesthetic drugs: a pediatric perspective. Paediatr Anaesth. 2012;22(1):39–43.

    PubMed  Google Scholar 

  38. Neal JM, Mulroy MF, Weinberg GL. American Society of Regional Anesthesia and Pain Medicine checklist for managing local anesthetic system toxicity: 2012 version. Reg Anesth Pain Med. 2012;37(1):8–15.

    PubMed  Google Scholar 

  39. Patil K. Use of intralipid for local anesthetic toxicity in neonates. Paediatr Anaesth. 2011;21(12):1268–9.

    PubMed  Google Scholar 

  40. Presley JD, Chyka PA. Intravenous lipid emulsion to reverse acute drug toxicity in pediatric patients. Ann Pharmacother. 2013;47(5):735–43.

    PubMed  Google Scholar 

  41. Cave G, Harvey M, Willers J, et al. LIPAEMIC report: results of clinical use if intravenous lipid emulsion in drug toxicity reported to an online lipid registry. J Med Toxicol. 2014;10(2):133–42.

    CAS  PubMed  PubMed Central  Google Scholar 

  42. Perruchoud C, Chollet-Rivier M. Cardiac arrest during induction of anaesthesia in a child on long-term amphetamine therapy. Br J Anaesth. 2008;100(3):421–2.

    CAS  PubMed  Google Scholar 

  43. Stricker PA, Goobie SM, Cladis FP, et al. Perioperative outcomes and management in pediatric complex cranial vault reconstruction. Anesthesiology 2017:126(2) [epub]

  44. Lalwani K, Aliason I. Cardiac arrest in the neonate during laparoscopic surgery. Anesth Analg. 2009;109:760–2.

    PubMed  Google Scholar 

  45. Olsen M, Avery N, Khurana S, Laing R. Pneumoperitoneum for neonatal laparoscopy: how safe is it? Pediatr Anesth. 2013;23:457–9.

    Google Scholar 

  46. Murat I, Humblot A, Girault L. Les risques de l’anesthesie pediatrique. Ann Fr Anesth Reanim. 2009;28:666–70.

    CAS  PubMed  Google Scholar 

  47. Laxenaire MC. Substances responsible for peranesthetic anaphylactic shock. A third French multicenter study (1992-94). Ann Fr Anesth Reanim. 1996;15:1211–8.

    CAS  PubMed  Google Scholar 

  48. Mertes PM, Alla F, Tréchot P, et al. Anaphylaxis during anesthesia in France: an 8-year national survey. J Allergy Clin Immunol. 2011;128:366–73.

    PubMed  Google Scholar 

  49. Truhlar A, Deakin CD, Soar J, et al. European resuscitation council guidelines for resuscitation 2015. Section 4. Cardiac arrest in special circumstances. Rescuscitation. 2015;95:148–201.

    Google Scholar 

  50. Alders M, Christiaans I. Long QT syndrome. In: Pagon RA, Adam MP, Ardinger HH, Wallace SE, Amemiya A, LJH B, Bird TD, Fong CT, Mefford HC, RJH S, Stephens K, editors. GeneReviews® [Internet]. Seattle: University of Washington, Seattle; 2003. p. 1993–2016. Feb 20 [updated 2015 Jun 18].

    Google Scholar 

  51. Nathan AT, Berkowitz DH, Montenegro LM, et al. Implications of anesthesia in children with long QT syndrome. Anesth Analg. 2011;112(5):1163–8.

    CAS  PubMed  Google Scholar 

  52. Whyte SD, Nathan A, Myers D, et al. The safety of modern anesthesia for children with long QT syndrome. Anesth Analg. 2014;119(4):932–8.

    CAS  PubMed  Google Scholar 

  53. Lerman J. Anterior mediastinal masses in children. Seminars in Anesthesia, perioperative medicine and pain. 2007;26:133–40.

    Google Scholar 

  54. Menga EN, Hirschfeld C, Jain A. Intraoperative cardiopulmonary arrest in children undergoing spinal deformity correction: causes and associated factors. Spine. 2015;40(22):1757–62.

    PubMed  Google Scholar 

  55. Bales JG, Colon J, Ramadyani U, LeDoux E, Bennet JT. Electrocautery-induced asystole in a scoliosis patient with a pacemaker. J Pediatr Orthop B. 2007;16(1):19–22.

    PubMed  Google Scholar 

  56. Lee JH, Kim EK, Song IK, et al. Critical incidents, including cardiac arrest, associated with pediatric anesthesia at a tertiary teaching children’s hospital. Pediatr Anesth. 2016;26:409–17.

    Google Scholar 

  57. Abraham M, Wadhawan M, Gupta V, Singh AK. Cardiopulmonary resuscitation in the lateral position: is it feasible during pediatric intracranial surgery? Anesthesiology. 2009;110:1185–6.

    PubMed  Google Scholar 

  58. International liaison Committee on Resuscitation. 2005 international consensus on cardiopulmonary resuscitation and emergency cardiovascular care science with treatment recommendations. Circulation. 2005;112:206–11.

    Google Scholar 

  59. Zoeller GK, Zallen GS, Glick PL. Cardiopulmonary resuscitation in patients with a Nuss bar—a case report and review of the literature. J Pediatr Surg. 2005;40(11):1788–91.

    PubMed  Google Scholar 

  60. Ghai B, Makkar JK, Arora S. Intraoperative cardiac arrest because of oculocardiac reflex and subsequent pulmonary edema in a patient with extraocular cysticercosis. Pediatr Anesth. 2006;16:1193–202.

    Google Scholar 

  61. Fayon M, Gauthier M, Blanc VF, et al. Intraoperative cardiac arrest due to the oculocardiac reflex and subsequent death in a child with occult Epstein-Barr virus myocarditis. Anesthesiology. 1995;83(3):622–4.

    CAS  PubMed  Google Scholar 

  62. Raymond TT, Cunningham CB, Thompson MT, et al. Outcomes among neonates, infants, and children after extracorporeal cardiopulmonary resuscitation for refractory in hospital pediatric cardiac arrest: a report from the National Registry of Cardiopulmonary Resuscitation. Pediatr Crit Care. 2010;11(3):362–71.

    Google Scholar 

  63. •• Lasa JJ, Rogers RS, Localio R, et al. E-CPR during pediatric in-hospital cardiopulmonary arrest is associated with improved survival to discharge: a report from the American Heart Association’s get with the guidelines-resuscitation registry. Circulation. 2016;133(2):165–76. This study opens a chance to a relative new CPR technique. For children with in-hospital CPR of ≥10 minutes duration, E-CPR was associated with improved survival to hospital discharge and survival with favorable neurological outcome compared with C-CPR.

    PubMed  Google Scholar 

  64. Keenan RL, Shapiro JH, Dawson K. Frequency of anesthetic cardiac arrest in infants: effect of pediatric anesthesiologists. J Clin Anesth. 1991;3(6):433–7.

    CAS  PubMed  Google Scholar 

  65. •• Bhanji F, Tropjian AA, Nadkarni VM, et al. Survival rates following pediatric in-hospital cardiac arrest during nights and weekend. JAMA Pediatr. 2016;7 doi:10.1001/jamapediatrics.2016.2535. Analyze 12,404 cases of pediatric in-hospital cardiac arrest and measure, survival to hospital discharge, and correlation with day/nightime or week/weekend days.

  66. Section on Anesthesia, American Academy of Pediatrics. Guidelines for the pediatric perioperative anesthesia environment. Pediatrics. 1999;103:512–5.

    Google Scholar 

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Authors and Affiliations

  1. Neonatal and Pediatric Intensive Care Unit, Istituto Giannina Gaslini, L.goG.Gaslini 5, 16147, Genova, Italy

    Elisabetta Lampugnani & Andrea Moscatelli

  2. Clinical Professor of Anesthesia, Women and Children’s Hospital of Buffalo, SUNY at Buffalo, Buffalo, NY, 14222, USA

    Jerrold Lerman

  3. School of Anesthesia & Intensive Care, University of Catania, Catania, Italy

    Chiara Grasso

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  1. Elisabetta Lampugnani
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  2. Jerrold Lerman
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  3. Chiara Grasso
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  4. Andrea Moscatelli
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Correspondence to Elisabetta Lampugnani.

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Elisabetta Lampugnani, Jerrold Lerman, Chiara Grasso, Andrea Moscatelli declare they have no conflic ts of interest.

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Lampugnani, E., Lerman, J., Grasso, C. et al. Cardiac Arrest in Children. Curr Anesthesiol Rep 7, 183–190 (2017). https://doi.org/10.1007/s40140-017-0215-8

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