Peri‐operative cardiac arrest in children as reported to the 7th National Audit Project of the Royal College of Anaesthetists

F. C. Oglesby; B. R. Scholefield; T. M. Cook; J. H. Smith; V. J. Pappachan; A. D. Kane; RA Armstrong; E. Kursumovic; J. Soar

doi:10.1111/anae.16251

Peri‐operative cardiac arrest in children as reported to the 7th National Audit Project of the Royal College of Anaesthetists

F. C. Oglesby, B. R. Scholefield, T. M. Cook^*, J. H. Smith, V. J. Pappachan, A. D. Kane, RA Armstrong, E. Kursumovic, J. Soar

^*Corresponding author for this work

Inflammation and Ageing

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Abstract

The 7th National Audit Project of the Royal College of Anaesthetists studied peri‐operative cardiac arrest. An activity survey estimated UK paediatric anaesthesia annual caseload as 390,000 cases, 14% of the UK total. Paediatric peri‐operative cardiac arrests accounted for 104 (12%) reports giving an incidence of 3 in 10,000 anaesthetics (95%CI 2.2–3.3 per 10,000). The incidence of peri‐operative cardiac arrest was highest in neonates (27, 26%), infants (36, 35%) and children with congenital heart disease (44, 42%) and most reports were from tertiary centres (88, 85%). Frequent precipitants of cardiac arrest in non‐cardiac surgery included: severe hypoxaemia (20, 22%); bradycardia (10, 11%); and major haemorrhage (9, 8%). Cardiac tamponade and isolated severe hypotension featured prominently as causes of cardiac arrest in children undergoing cardiac surgery or cardiological procedures. Themes identified at review included: inappropriate choices and doses of anaesthetic drugs for intravenous induction; bradycardias associated with high concentrations of volatile anaesthetic agent or airway manipulation; use of atropine in the place of adrenaline; and inadequate monitoring. Overall quality of care was judged by the panel to be good in 64 (62%) cases, which compares favourably with adults (371, 52%). The study provides insight into paediatric anaesthetic practice, complications and peri‐operative cardiac arrest.

Original language	English
Journal	Anaesthesia
Early online date	18 Feb 2024
DOIs	https://doi.org/10.1111/anae.16251
Publication status	E-pub ahead of print - 18 Feb 2024

Bibliographical note

Acknowledgments:
The project infrastructure is supported financially and with staffing from the Royal College of Anaesthetists. Other NAP7 panel and team members are: S. Agarwal; J. Cordingley; L. Cortes; M. T. Davies; J. Dorey; S. J. Finney; S. Kendall; G. Kunst; J. Lourtie; D.N. Lucas; I. K. Moppett; R. Mouton; G. Nickols; J. P. Nolan; B. Patel; F. Plaat; K. Samuel; C. Taylor; L. Varney; and E. Wain. We thank all NAP7 local reporters and their teams and all UK anaesthetists who completed surveys or submitted cases. The NAP7 fellows' salaries were supported by: South Tees Hospitals NHS Foundation Trust (AK); Royal United Hospitals Bath NHS Foundation (EK); NIHR Academic Clinical Fellowship (RA). Panel members receive travel expenses and no remuneration. JS and TMC's employers receive backfill for their time on the project (4 hours per week). We thank the HSRC/RCoA research team including K. Williams (Audit Coordinator), J. Lourtie (Head of Research) and S. Drake (Director of Clinical Quality and Research) for supporting and collaborating on the project. No other conflicts of interests declared.

Keywords

cardiac arrest
paediatric
anaesthesia
NAP7

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title = "Peri‐operative cardiac arrest in children as reported to the 7th National Audit Project of the Royal College of Anaesthetists",

abstract = "The 7th National Audit Project of the Royal College of Anaesthetists studied peri‐operative cardiac arrest. An activity survey estimated UK paediatric anaesthesia annual caseload as 390,000 cases, 14% of the UK total. Paediatric peri‐operative cardiac arrests accounted for 104 (12%) reports giving an incidence of 3 in 10,000 anaesthetics (95%CI 2.2–3.3 per 10,000). The incidence of peri‐operative cardiac arrest was highest in neonates (27, 26%), infants (36, 35%) and children with congenital heart disease (44, 42%) and most reports were from tertiary centres (88, 85%). Frequent precipitants of cardiac arrest in non‐cardiac surgery included: severe hypoxaemia (20, 22%); bradycardia (10, 11%); and major haemorrhage (9, 8%). Cardiac tamponade and isolated severe hypotension featured prominently as causes of cardiac arrest in children undergoing cardiac surgery or cardiological procedures. Themes identified at review included: inappropriate choices and doses of anaesthetic drugs for intravenous induction; bradycardias associated with high concentrations of volatile anaesthetic agent or airway manipulation; use of atropine in the place of adrenaline; and inadequate monitoring. Overall quality of care was judged by the panel to be good in 64 (62%) cases, which compares favourably with adults (371, 52%). The study provides insight into paediatric anaesthetic practice, complications and peri‐operative cardiac arrest.",

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author = "Oglesby, {F. C.} and Scholefield, {B. R.} and Cook, {T. M.} and Smith, {J. H.} and Pappachan, {V. J.} and Kane, {A. D.} and RA Armstrong and E. Kursumovic and J. Soar",

note = "Acknowledgments: The project infrastructure is supported financially and with staffing from the Royal College of Anaesthetists. Other NAP7 panel and team members are: S. Agarwal; J. Cordingley; L. Cortes; M. T. Davies; J. Dorey; S. J. Finney; S. Kendall; G. Kunst; J. Lourtie; D.N. Lucas; I. K. Moppett; R. Mouton; G. Nickols; J. P. Nolan; B. Patel; F. Plaat; K. Samuel; C. Taylor; L. Varney; and E. Wain. We thank all NAP7 local reporters and their teams and all UK anaesthetists who completed surveys or submitted cases. The NAP7 fellows' salaries were supported by: South Tees Hospitals NHS Foundation Trust (AK); Royal United Hospitals Bath NHS Foundation (EK); NIHR Academic Clinical Fellowship (RA). Panel members receive travel expenses and no remuneration. JS and TMC's employers receive backfill for their time on the project (4 hours per week). We thank the HSRC/RCoA research team including K. Williams (Audit Coordinator), J. Lourtie (Head of Research) and S. Drake (Director of Clinical Quality and Research) for supporting and collaborating on the project. No other conflicts of interests declared.",

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AU - Scholefield, B. R.

AU - Cook, T. M.

AU - Smith, J. H.

AU - Pappachan, V. J.

AU - Kane, A. D.

AU - Armstrong, RA

AU - Kursumovic, E.

AU - Soar, J.

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N2 - The 7th National Audit Project of the Royal College of Anaesthetists studied peri‐operative cardiac arrest. An activity survey estimated UK paediatric anaesthesia annual caseload as 390,000 cases, 14% of the UK total. Paediatric peri‐operative cardiac arrests accounted for 104 (12%) reports giving an incidence of 3 in 10,000 anaesthetics (95%CI 2.2–3.3 per 10,000). The incidence of peri‐operative cardiac arrest was highest in neonates (27, 26%), infants (36, 35%) and children with congenital heart disease (44, 42%) and most reports were from tertiary centres (88, 85%). Frequent precipitants of cardiac arrest in non‐cardiac surgery included: severe hypoxaemia (20, 22%); bradycardia (10, 11%); and major haemorrhage (9, 8%). Cardiac tamponade and isolated severe hypotension featured prominently as causes of cardiac arrest in children undergoing cardiac surgery or cardiological procedures. Themes identified at review included: inappropriate choices and doses of anaesthetic drugs for intravenous induction; bradycardias associated with high concentrations of volatile anaesthetic agent or airway manipulation; use of atropine in the place of adrenaline; and inadequate monitoring. Overall quality of care was judged by the panel to be good in 64 (62%) cases, which compares favourably with adults (371, 52%). The study provides insight into paediatric anaesthetic practice, complications and peri‐operative cardiac arrest.

AB - The 7th National Audit Project of the Royal College of Anaesthetists studied peri‐operative cardiac arrest. An activity survey estimated UK paediatric anaesthesia annual caseload as 390,000 cases, 14% of the UK total. Paediatric peri‐operative cardiac arrests accounted for 104 (12%) reports giving an incidence of 3 in 10,000 anaesthetics (95%CI 2.2–3.3 per 10,000). The incidence of peri‐operative cardiac arrest was highest in neonates (27, 26%), infants (36, 35%) and children with congenital heart disease (44, 42%) and most reports were from tertiary centres (88, 85%). Frequent precipitants of cardiac arrest in non‐cardiac surgery included: severe hypoxaemia (20, 22%); bradycardia (10, 11%); and major haemorrhage (9, 8%). Cardiac tamponade and isolated severe hypotension featured prominently as causes of cardiac arrest in children undergoing cardiac surgery or cardiological procedures. Themes identified at review included: inappropriate choices and doses of anaesthetic drugs for intravenous induction; bradycardias associated with high concentrations of volatile anaesthetic agent or airway manipulation; use of atropine in the place of adrenaline; and inadequate monitoring. Overall quality of care was judged by the panel to be good in 64 (62%) cases, which compares favourably with adults (371, 52%). The study provides insight into paediatric anaesthetic practice, complications and peri‐operative cardiac arrest.

KW - cardiac arrest

KW - paediatric

KW - anaesthesia

KW - NAP7

U2 - 10.1111/anae.16251

DO - 10.1111/anae.16251

M3 - Article

SN - 0003-2409

JO - Anaesthesia

JF - Anaesthesia

ER -

Peri‐operative cardiac arrest in children as reported to the 7th National Audit Project of the Royal College of Anaesthetists

Abstract

Bibliographical note

Keywords

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