Universität zu Köln

Hohn, Andreas, Trieschmann, Uwe, Franklin, Jeremy ORCID: 0000-0003-1536-0925, Machatschek, Jan-Nicolas, Kaufmann, Jost ORCID: 0000-0002-5289-6465, Herff, Holger, Hinkelbein, Jochen, Annecke, Thorsten ORCID: 0000-0002-2496-4432, Boettiger, Bernd W. and Padosch, Stephan A. (2019). Incidence of peri-operative paediatric cardiac arrest and the influence of a specialised paediatric anaesthesia team Retrospective cohort study. Eur. J. Anaesth., 36 (1). S. 55 - 64. PHILADELPHIA: LIPPINCOTT WILLIAMS & WILKINS. ISSN 1365-2346

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Abstract

BACKGROUND Peri-operative critical events are still a major problem in paediatric anaesthesia care. Access to more experienced healthcare teams might reduce the adverse event rate and improve outcomes. OBJECTIVE The current study analysed incidences of perioperative paediatric cardiac arrest before and after implementation of a specialised paediatric anaesthesia team and training programme. DESIGN Retrospective cohort study with before- and-after analysis. SETTING Department of Anaesthesiology and Intensive Care Medicine, University Hospital of Cologne, Germany. PATIENTS A total of 36 243 paediatric anaesthetics (0 to 18 years) were administered between 2008 and 2016. INTERVENTION Implementation of a specialised paediatric anaesthesia team and training programme occurred in 2014 This included hands-on supervised training in all fields of paediatric anaesthesia, double staffing for critical paediatric cases and a 24/7 emergency team. A logistic regression analysis with risk factors (age, ASA physical status, emergency) was used to evaluate the impact of implementation of the specialised paediatric anaesthesia team. MAIN OUTCOME MEASURES Incidences of peri-operative paediatric cardiac arrest and anaesthesia-attributable cardiac arrest before and after the intervention. RESULTS Twelve of 25 paediatric cardiac arrests were classified as anaesthesia-attributable. The incidence of overall peri-operative paediatric cardiac arrest was 8.1/10 000 (95% CI 5.2 to 12.7) in the period 2008 to 2013 and decreased to 4.6/10 000 (95% CI 2.1 to 10.2) in 2014 to 2016. Likewise, the incidence of anaesthesia-attributable cardiac arrest was lower after 2013 [1.6/10 000 (95% CI 0.3 to 5.7) vs. 4.3/ 10 000 (95% CI 2.3 to 7.9)]. Using logistic regression, children anaesthetised after 2013 had nearly a 70% lower probability of anaesthesia-attributable cardiac arrest (odds ratio 0.306, 95% CI 0.067 to 1.397; P = 0.1263). For anaesthesia- attributable cardiac arrest, young age was the most contributory risk factor, whereas in overall paediatric cardiac arrest, ASA physical statuses 3 to 5 played a more important role. CONCLUSION In this study on incidences of peri-operative paediatric cardiac arrest from a European tertiary care university hospital, implementation of a specialised paediatric anaesthesia team and training programme was associated with lower incidences of peri-operative paediatric cardiac arrest and a reduced probability of anaesthesia-attributable cardiac arrest.

Item Type:	Journal Article
Creators:	Creators Email ORCID ORCID Put Code Hohn, Andreas UNSPECIFIED UNSPECIFIED UNSPECIFIED Trieschmann, Uwe UNSPECIFIED UNSPECIFIED UNSPECIFIED Franklin, Jeremy UNSPECIFIED orcid.org/0000-0003-1536-0925 UNSPECIFIED Machatschek, Jan-Nicolas UNSPECIFIED UNSPECIFIED UNSPECIFIED Kaufmann, Jost UNSPECIFIED orcid.org/0000-0002-5289-6465 UNSPECIFIED Herff, Holger UNSPECIFIED UNSPECIFIED UNSPECIFIED Hinkelbein, Jochen UNSPECIFIED UNSPECIFIED UNSPECIFIED Annecke, Thorsten UNSPECIFIED orcid.org/0000-0002-2496-4432 UNSPECIFIED Boettiger, Bernd W. UNSPECIFIED UNSPECIFIED UNSPECIFIED Padosch, Stephan A. UNSPECIFIED UNSPECIFIED UNSPECIFIED
URN:	urn:nbn:de:hbz:38-139257
DOI:	10.1097/EJA.0000000000000863
Journal or Publication Title:	Eur. J. Anaesth.
Volume:	36
Number:	1
Page Range:	S. 55 - 64
Date:	2019
Publisher:	LIPPINCOTT WILLIAMS & WILKINS
Place of Publication:	PHILADELPHIA
ISSN:	1365-2346
Language:	English
Faculty:	Unspecified
Divisions:	Unspecified
Subjects:	no entry
Uncontrolled Keywords:	Keywords Language EUROPEAN RESUSCITATION COUNCIL; ADVANCED LIFE-SUPPORT; YOUNG-CHILDREN; RISK-FACTORS; MORTALITY; COMPLICATIONS; ASSOCIATION; GUIDELINES; STATEMENT; CONSENSUS Multiple languages Anesthesiology Multiple languages
Refereed:	Yes
URI:	http://kups.ub.uni-koeln.de/id/eprint/13925