Anesthesiology 93: 6-14, 2000

Submitted by Ann Bailey

Summary: 289 cases of cardiac arrest in children were voluntarily reported by 63 institutions (UNC being one of them). 150 arrests were judged to be related to anesthesia, with incidence of 1.4/10,000 anesthetics.

Most common causes: medication (usually halothane overdose) and cardiovascular. Infants < 1 year of age accounted for 55% of arrests. ASA 3-5 pts and emergencies predicted mortality.

Methods: Voluntary enrollment by 63 institutions from 1994-1997; all children who received chest compressions in OR were enrolled, regardless of etiology. Objective review of cases with information available; sorted into classification by etiology of arrest.

Results:

• Over 1,000,000 anesthetics delivered. 150 anesthetic related arrests.
• Infants < 1 year were 55% of cases
• Medication related: 55 events: 26 were halothane alone, 11 were halothane and other medication
• 66% halothane arrests occurred during induction; 34% during maintenance
• 2 arrests were ASA 3 pts who arrested with sevoflurane during induction
• 4 cases of arrest due to intravascular injection of bupivacaine with epi during caudal injections
• Most cardiovascular causes included underlying CV disease, ASA 3-5, hemorrhage or its therapy
• Respiratory events only accounted for 20% of all arrests; laryngospasm = 9 pts (mostly ASA 1-2)

Study is flawed by the voluntary nature of reporting; many cases were not reported , and without knowing correctly the numerator or the denominator it is hard to make definitive conclusions. Unlike closed claim studies, respiratory events were not common antecedents to cardiac arrest.