(1513) Characteristics of Pediatric Perioperative Cardiopulmonary Arrest

Introduction: Pediatric cardiopulmonary arrest (CPA) in the perioperative setting is a rare but high-risk event, poorly described in current literature in children undergoing non-cardiac surgery. The aim of this study was to determine characteristics and outcomes of perioperative CPA events for children undergoing non-cardiac procedures.

Methods: We conducted a retrospective observational cohort study at a single academic children’s hospital from January 2013 to July 2023. Children less than 18 years of age with a CPA event reported to the American Heart Association Get With the Guidelines-Resuscitation registry were included. Perioperative CPA was defined as occurring intraoperatively or within 24 hours of anesthesia. Descriptive statistics were used to characterize data.

Results: A total of 835 pediatric in-hospital CPA events were recorded during the study period. Of these, 182 (22%) were perioperative, with 134 (16%) perioperative events for non-cardiac procedures included in analysis. Event timing was intraoperative, n=66 (49%), and within 24 hours post-anesthesia, n=68 (51%). Seventy-two children (44%) were under one year of age, with higher representation in the post-anesthesia group (65%, 44/68). Of 68 post-anesthesia events, 48 occurred in a pediatric or neonatal intensive care unit, 6 in the post anesthesia care unit, and 18 in other sites (telemetry unit, diagnostic/interventional radiology, and cardiac catheterization lab). Return of circulation (ROC) was achieved in 126/134 (94%), with higher event mortality in the intraoperative group (6/66, 9%) vs post-anesthesia group (2/68, 3%). Extracorporeal cardiopulmonary resuscitation (ECPR) was employed in 16/134 (12%) events, with 10/66 (15%) intraoperative and 6/68 (9%) post-anesthesia. Perioperative ECPR event mortality was 3/16 (19%).

Conclusions: Although perioperative CPA occurs in only a small fraction of anesthetics performed, it accounts for 16% of all pediatric CPA events in this cohort. Seventy percent of postoperative events occurred in an intensive care unit, suggesting under-recognition of illness severity among the remaining patients. Most pediatric patients achieved ROC following perioperative CPA events; further studies are needed to evaluate risk factors for CPA, to mitigate risk and implement perioperative CPA preventive strategies.