Anesthesia-Related Cardiac Arrest in Children: Update from the Pediatric Perioperative Cardiac Arrest Registry Sanjay M. Bhananker, MD, FRCA* Chandra Ramamoorthy, MD† Jeremy M. Geiduschek, MD* Karen L. Posner, PhD* Karen B. Domino, MD, MPH* Charles M. Haberkern, MD, MPH* John S. Campos, MA* Jeffrey P. Morray, MD‡ BACKGROUND: The initial findings from the Pediatric Perioperative Cardiac Arrest (POCA) Registry (1994 –1997) revealed that medication-related causes, often car- diovascular depression from halothane, were the most common. Changes in pediatric anesthesia practice may have altered the causes of cardiac arrest in anesthetized children. METHODS: Nearly 80 North American institutions that provide anesthesia for children voluntarily enrolled in the Pediatric Perioperative Cardiac Arrest Registry. A standardized data form for each perioperative cardiac arrest in children 18 yr of age was submitted anonymously. We analyzed causes of anesthesia-related cardiac arrests and related factors in 1998 –2004. RESULTS: From 1998 to 2004, 193 arrests (49%) were related to anesthesia. Medication-related arrests accounted for 18% of all arrests, compared with 37% from 1994 to 1997 (P  0.05). Cardiovascular causes of cardiac arrest were the most common (41% of all arrests), with hypovolemia from blood loss and hyperkalemia from transfusion of stored blood the most common identifiable cardiovascular causes. Among respiratory causes of arrest (27%), airway obstruction from laryn- gospasm was the most common cause. Vascular injury incurred during placement of central venous catheters was the most common equipment-related cause of arrest. The cause of arrest varied by phase of anesthesia care (P  0.01). Cardiovascular and respiratory causes occurred most commonly in the surgical and postsurgical phases, respectively. CONCLUSIONS: A reduction in the proportion of arrests related to cardiovascular depression due to halothane may be related to the declining use of halothane in pediatric anesthetic practice. The incidence of the most common remaining causes of arrest in each category may be reduced through preventive measures. (Anesth Analg 2007;105:344 –50) The Pediatric Perioperative Cardiac Arrest (POCA) Registry was formed in 1994 to study the causes and outcomes from perioperative cardiac arrests in anes- thetized children. The initial findings of the POCA registry were reported by Morray et al. (1). Medication-related cardiac arrests, particularly those due to the cardiovascular depressant effects of halo- thane, were the most common, and often occurred in American Society of Anesthesiologists (ASA) physical status 1–2 children younger than 1-year-of-age. Over the last decade, halothane use has declined in favor of sevoflurane. Given that sevoflurane has been reported to cause less bradycardia (2,3) and myocardial depres- sion (4,5) compared to halothane, the profile of cardiac arrest in anesthetized children may have changed as well. We therefore analyzed the cases submitted to the POCA Registry in the 7 yr since the original report to investigate the causes and outcomes from periopera- tive cardiac arrests in children. METHODS This study was approved by the University of Washington IRB. The POCA Registry was formed in 1994. Data were collected from voluntary enrollment of institutions in the United States and Canada that provide anesthetic care to children. This study in- cludes cases submitted by enrolled institutions in 1998 –2004. During this time, an average of 68  9 (range, 58 –79) institutions was enrolled each year in the POCA registry. Seventy-two percent of these in- stitutions were university-affiliated hospitals, 16% community hospitals, 4% government or military hos- pitals, and 9% other. The data collection process has been described in detail (1). Briefly, a designated representative from each From the *Department of Anesthesiology, University of Wash- ington School of Medicine, Seattle, Washington; †Department of Anesthesiology, Stanford University School of Medicine, Palo Alto, California; and ‡Department of Anesthesiology, Phoenix Children’s Hospital and Valley Anesthesiology Consultants, Phoenix, Arizona. Accepted for publication April 19, 2007. Supported in part by the American Society of Anesthesiologists (ASA), Park Ridge, IL, as part of the Closed Claims Project. All opinions expressed are those of the authors and do not necessarily reflect those of the ASA. Address correspondence and reprint requests to Sanjay Bhananker, MD, FRCA, Department of Anesthesiology, Harborview Medical Center, 325 Ninth Avenue, Box 359724, Seattle, WA 98104-2499. Address e-mail to kdomino@u.washington.edu. Copyright © 2007 International Anesthesia Research Society DOI: 10.1213/01.ane.0000268712.00756.dd Vol. 105, No. 2, August 2007 344