title: Pediatric cardiopulmonary arrest in the postanesthesia care unit: analysis of data from the American Heart Association Get With The Guidelines-Resuscitation registry.
abstract: BACKGROUND
  Nearly 20% of anesthesia-related pediatric cardiopulmonary arrests (CPAs) occur during emergence or recovery. The aims of this study were to describe (i) the nature of pediatric postanesthesia care unit (PACU) CPA and subsequent outcomes and (ii) factors associated with mortality.
  
  
  METHODS
  Cardiopulmonary Arrests occurring in PACU in children (<18 years) were identified from the American Heart Association Get With The Guidelines-Resuscitation, multicenter CPA registry. Demographics, underlying conditions, cause(s) of CPA, monitoring, interventions and outcomes were extracted. Descriptive statistics were used to characterize data, and odds ratios (OR) with confidence intervals (CI) were calculated as appropriate to compare survivors and nonsurvivors.
  
  
  RESULTS
  Twenty seven CPA events were included: 67% in children <5 years and 30% in infants (<1 year). Most children (78%) had underlying comorbidities, including 15% with congenital heart disease. Respiratory issues were the most frequent causes of CPA (44%), but cardiac/hemodynamic causes were associated with nonsurvival (P = 0.01). Nonsurvival was also associated with older age (P = 0.02), weekend occurrence (P < 0.01), nonpediatric setting (P = 0.02) and occurrence at night (P = 0.04).
  
  
  CONCLUSIONS
  This study identified similar risk factors and underlying causes as described in previous reports of pediatric perioperative CPA, with higher mortality following a cardiac/hemodynamic cause.
authors.affiliation: Department of Anesthesiology, University of Michigan Health System, Ann Arbor 48109, USA. robertec@med.umich.edu
authors.forename: Robert
authors.initials: R
authors.lastname: Christensen
authors.forename: Terri
authors.initials: T
authors.lastname: Voepel-Lewis
authors.forename: Ian
authors.initials: I
authors.lastname: Lewis
authors.forename: Satya Krishna
authors.initials: SK
authors.lastname: Ramachandran
authors.forename: Shobha
authors.initials: S
authors.lastname: Malviya
mesh_terms: D000572:American Heart Association; D000762:Anesthesia Recovery Period; D016887:Cardiopulmonary Resuscitation / Q000379:methods* / Q000592:standards*; D002675:Child, Preschool; D015897:Comorbidity; D016001:Confidence Intervals; D004777:Environment; D005260:Female; D019983:Guideline Adherence; D017408:Guidelines as Topic; D006323:Heart Arrest / Q000453:epidemiology / Q000401:mortality / Q000628:therapy*; D006801:Humans; D007223:Infant; D008297:Male; D016017:Odds Ratio; D011997:Recovery Room; D012042:Registries; D012307:Risk Factors; D016019:Survival Analysis; D017741:Survivors; D016896:Treatment Outcome; D014481:United States