An update on the mechanisms and risk factors for anesthesia-related cardiac arrest in children: a narrative review
Atualização sobre os mecanismos e fatores de risco para parada cardíaca relacionada à anestesia em crianças: uma revisão narrativa
Leandro Gobbo Braz, Jose Reinaldo Cerqueira Braz, Teofilo Augusto Araújo Tiradentes, Daniela de Sa Menezes Porto, Cristiano Martins Beserra, Luiz Antonio Vane, Paulo do Nascimento Junior, Norma Sueli Pinheiro Modolo, Mariana Gobbo Braz
Abstract
The relationship between surgery and anesthesia safety in children and the country's Human Development Index (HDI) value has been described previously. The aim of this narrative review was to provide an update on the mechanisms and risk factors of Anesthesia-Related Cardiac Arrest (ARCA) in pediatric surgical patients in countries with different HDI values and over time (pre-2001 vs. 2001‒2024). Electronic databases were searched up to March 2024 for studies reporting ARCA events in children. HDI values range from 0 to 1 (very-high-HDI countries: ≥ 0.800, high-HDI countries: 0.700‒0.799, medium-HDI countries: 0.550‒0.699, and low-HDI countries: < 0.550). Independent of time, the proportion of children who suffered perioperative Cardiac Arrest (CA) attributed to anesthesia-related causes was higher in very-high-HDI countries (50%) than in countries with HDI values less than 0.8 (15%‒36%), but ARCA rates were higher in countries with HDI values less than 0.8 than in very-high-HDI countries. Regardless of the HDI value, medication-related factors were the most common mechanism causing ARCA before 2001, while cardiovascular-related factors, mainly hypovolemia, and respiratory-related factors, including difficulty maintaining patent airways and adequate ventilation, were the major mechanisms in the present century. Independent of HDI value and time, a higher number of ARCA events occurred in children with heart disease and/or a history of cardiac surgery, those aged younger than one year, those with ASA physical status III‒V, and those who underwent emergency surgery. Many ARCA events were determined to be preventable. The implementation of specialized pediatric anesthesiology and training programs is crucial for anesthesia safety in children.
Keywords
Resumo
A relação entre a segurança da cirurgia e da anestesia em crianças e o valor do Índice de Desenvolvimento Humano (IDH) de um país foi descrita anteriormente. O objetivo desta revisão narrativa foi fornecer uma atualização sobre os mecanismos e fatores de risco da Parada Cardíaca Relacionada à Anestesia (PCRA) em pacientes cirúrgicos pediátricos em países com diferentes valores de IDH e ao longo do tempo (pré-2001 vs. 2001-2024). As bases de dados eletrônicas foram pesquisadas até março de 2024 em busca de estudos que relatassem eventos de PCRA em crianças. Os valores do IDH variam de 0 a 1 (países com IDH muito alto: ≥ 0,800, países com IDH alto: 0,700-0,799, países com IDH médio: 0,550-0,699 e países com IDH baixo: < 0,550). Independentemente do tempo, a proporção de crianças que sofreram Parada Cardíaca (PC) perioperatória atribuída a causas relacionadas à anestesia foi maior em países com IDH muito alto (50%) do que em países com valores de IDH inferiores a 0,8 (15‒36%) , mas as taxas de PCRA foram mais elevadas em países com valores de IDH inferiores a 0,8 do que em países com IDH muito elevado. Independentemente do valor do IDH, os factores relacionados com a medicação eram o mecanismo mais comum que causava PCRA antes de 2001, enquanto os fatores relacionados com o sistema cardiovascular, principalmente a hipovolemia, e os fatores relacionados com a respiração, incluindo a dificuldade em manter vias aéreas patentes e ventilação adequada, eram os principais mecanismos no século atual. Independentemente do valor e do tempo do IDH, ocorreu maior número de eventos de PCRA em crianças com cardiopatia e/ou história de cirurgia cardíaca, menores de um ano, com estado físico ASA III‒V e submetidas a cirurgia de emergência. Muitos eventos de PCRA foram determinados como evitáveis. A implementação de programas especializados de anestesiologia pediátrica e treinamento é crucial para a segurança da anestesia em crianças.
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Submitted date:
11/27/2023
Accepted date:
05/07/2024
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