Intra- and Peri-Operative Cardiac Arrest in Pediatric Patients: Epidemiology, Risk Factors, Mechanisms, and Management Strategies.

Abstract

Intraoperative (IOCA) and perioperative cardiac arrest (POCA) in pediatric patients represents a rare but catastrophic event with significant implications for morbidity and mortality. Despite advances in anesthetic techniques, monitoring technology, and resuscitation protocols, the incidence of IOCA and POCA in children has remained relatively stable over the past two decades. In the pediatric noncardiac surgery population, the incidence ranges from approximately 3 to 22 per 10 000 cases. Key risk factors include young age, particularly neonates and infants, high American Society of Anesthesiologists (ASA) physical status classification, emergency surgery, the presence of congenital heart disease (CHD), and pulmonary hypertension. Respiratory events remain the leading cause of anesthesia-related cardiac arrest, with cardiovascular causes carrying a higher mortality. Prevention strategies emphasize preoperative risk stratification, team communication, and preparedness. Management requires rapid recognition, high-quality cardiopulmonary resuscitation, and consideration of extracorporeal cardiopulmonary resuscitation (ECPR) in refractory cases. This review synthesizes current evidence regarding the epidemiology, risk factors, mechanisms, and provides clinicians with management strategies for pediatric IOCA and POCA.