Global anaesthesia-related cardiac arrest rates in children: a systematic review and meta-analysis

An update on the mechanisms and risk factors for anesthesia-related cardiac arrest in children: a narrative review

“…A recent review of global studies involving children demonstrated that the rate of ARCA in children has not declined over the past 60 years and is inversely related to the HDI value. 11 This same review demonstrated that the worldwide rates of ARCA in high-HDI countries (HDI values ≥ 0.8) were 3.1-fold higher among children younger than one year old than among those aged one year or older before 2001 (5.54 vs. 1.76 per 10,000 anesthetic procedures) and 8-fold higher in 2001‒2022 (10.69 vs. 1.48 per 10,000 anesthetic procedures), while in low-HDI countries (HDI values < 0.8), these rates were 6.6-fold higher among children younger than one year old than among those ≥ 1 year of age before 2001 (10.46 vs. 1.67 per 10,000 anesthetic procedures) and 7.3-fold higher 2001‒2022 (36.02 vs. 2.86 per 10,000 anesthetic procedures). 11 According to the authors of the review, the high ARCA rate in children younger than one year old, even in very-high-HDI countries, may be due to the increase in the number of surgical patients with a poorer ASA physical status (≥ III), as demonstrated in a global systematic review of studies.…”

“… 11 This same review demonstrated that the worldwide rates of ARCA in high-HDI countries (HDI values ≥ 0.8) were 3.1-fold higher among children younger than one year old than among those aged one year or older before 2001 (5.54 vs. 1.76 per 10,000 anesthetic procedures) and 8-fold higher in 2001‒2022 (10.69 vs. 1.48 per 10,000 anesthetic procedures), while in low-HDI countries (HDI values < 0.8), these rates were 6.6-fold higher among children younger than one year old than among those ≥ 1 year of age before 2001 (10.46 vs. 1.67 per 10,000 anesthetic procedures) and 7.3-fold higher 2001‒2022 (36.02 vs. 2.86 per 10,000 anesthetic procedures). 11 According to the authors of the review, the high ARCA rate in children younger than one year old, even in very-high-HDI countries, may be due to the increase in the number of surgical patients with a poorer ASA physical status (≥ III), as demonstrated in a global systematic review of studies. 7 A study from a high-HDI country reported that the total proportion of children aged less than 1 year and the proportion of children aged less than one year with an ASA physical status of III to V were higher in the period from 2014 to 2016 than in the period from 2008 to 2013, confirming increases in underlying risks and complexity among pediatric surgical patients.…”

“…A recent systematic review of global studies involving children demonstrated that Anesthesia-Related Cardiac Arrest (ARCA) rates were inversely correlated with HDI values and did not change over time in either high-HDI countries (HDI value ≥ 0.8) or low-HDI countries (HDI value < 0.8); however, ARCA rates were significantly higher in low-HDI countries than in high-HDI countries and higher in children aged less than one year than in children aged 1 year or older in high-HDI and low-HDI countries. 11 …”

Advancing pediatric anesthesia in Brazil: reflections on research and education

“…Conversely, in underdeveloped and developing countries, the subspecialty scarcely exists, and anesthesiologists with little experience in pediatric anesthesia are often responsible for the care provided to children. 15 …”

“…For these reasons, programs that encourage the education of pediatric anesthesia and the work of individuals trained to handle children in resource-limited countries, such as ours, should be supported, as they play an important role in promoting safe anesthesia for children. 15 , 16 Being trained and accredited as a specialist by a recognized institution is the foundation for the future of perioperative care for this vulnerable population. 17…”