Intraoperative Cardiopulmonary Arrest in Children Undergoing Spinal Deformity Correction: Causes and Associated Factors.
METHODS
Retrospective review.


OBJECTIVE
To report the incidence of and risk factors for intraoperative cardiopulmonary arrest (ICA) in children undergoing spinal deformity surgery.


BACKGROUND
Spinal deformities in children are associated with comorbidities that can pose substantial risks during surgery.


METHODS
We reviewed records of patients who underwent surgery at two pediatric tertiary-care hospitals from 2004 through 2014. Fisher exact test and the Student t test were used to compare ICA and non-ICA groups by patient diagnosis, estimated blood loss, number of vertebral levels fused, and proportion of blood volume lost (significance, P < 0.05). We classified proximate causes of ICA based on hemoglobin, metabolic panel/electrolyte imbalance, electrocardiogram/echocardiography, and vital signs.


RESULTS
ICA occurred in 11 of 2524 (0.4%) patients. Patients with neuromuscular disorders had a 3-fold higher risk of ICA compared with those without neuromuscular disorders. At the time of ICA, hemoglobin levels were 5  g/dL or less in four patients, potassium was higher than 5.5  mEq/L in six patients, and ionized calcium was less than or equal to 1  mmol/L in two patients. There were significant differences between the ICA and non-ICA groups in mean number of vertebral levels fused (15 vs. 12), patient weight (34 vs. 49  kg), estimated blood loss (2623 vs. 959  mL), and proportion of blood volume lost (1.03 vs. 0.33) (all P < 0.01). Suspected causes of ICA were cardiovascular causes (eight patients) and anaphylaxis, primary rhythm disturbance, and respiratory/airway cause (one patient each). The incidence of ICA for patients with idiopathic scoliosis was 0.13%. Ten of the 11 patients were successfully resuscitated, and one patient died.


CONCLUSIONS
ICA occurs in approximately 0.4% of children undergoing spinal fusion surgery. Patients with neuromuscular disorders are at greater risk of ICA than those without these disorders.


METHODS
3.
*Department of Orthopaedic Surgery, The Johns Hopkins University, Baltimore, MD†Department of Anesthesiology, The Johns Hopkins University, Baltimore, MD‡Department of Orthopaedic Surgery, Texas Scottish Rite Hospital for Children, Dallas, TX.
Emmanuel N
EN
Menga
Cole
C
Hirschfeld
Amit
A
Jain
Dong-Phuong
DP
Tran
Heather D
HD
Caine
Dolores B
DB
Njoku
Lori A
LA
Karol
Paul D
PD
Sponseller
D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D005260:Female; D006323:Heart Arrest / Q000453:epidemiology / Q000209:etiology*; D006801:Humans; D015994:Incidence; D007223:Infant; D007431:Intraoperative Complications / Q000453:epidemiology / Q000209:etiology*; D008297:Male; D012307:Risk Factors; D012600:Scoliosis / Q000601:surgery*; D013123:Spinal Fusion / Q000009:adverse effects*; D016896:Treatment Outcome