Anesthesiologist-related factors associated with risk-adjusted pediatric anesthesia-related cardiopulmonary arrest: a retrospective two level analysis.


This single-centre, retrospective study examines the impact of anesthesiologist-related factors on anesthesia-related cardiac arrest and is an attempt to replicate the results of the work by Zgleszewski et al, in 2016. The latter showed a higher risk of anesthesia-related cardiac arrest for anesthesiologists with lower annual days of delivering anesthetics.


The 10-year data from a tertiary paediatric hospital included potential patient-related, system-related, and provider-related risk factors of anesthesia-related cardiac arrest. Cases were filtered from an anesthetic information management system and institutional and national databases.


109775 anesthetics were delivered over the decade. There were 240 confirmed cases of cardiac arrests of which 34.2% were identified as anesthesia-related.

Anesthesia-related cardiac arrest was statistically more prevalent with increasing ASA-PS (P<0.001), <180 days postnatal age (P<0.001), cardiac surgery (P<0.001), emergency cases (P=0.004), and trainee supervision (P=0.09). Most anesthesia-related cardiac arrests occurred in operating rooms (75%), during daytime hours (91%) and on weekdays (95%).

Anesthesiologist factors (provider characteristics and years of experience) were not associated with increased incidence of anesthesia-related cardiac arrest.


This study reported a significantly higher anesthesia-related cardiac arrest rate than previously reported in national registries and other single-institution studies. This may reflect this study’s population of significantly more patients with ASA-PS >3 and postnatal age <180 days.

The results of this study should be interpreted with caution for several reasons: This is a retrospective, single centre study. Cases missed when searching the database and the exclusion of paper anesthesia records may have resulted in undercounting. Unmeasured variables such as congenital heart disease or patients with pulmonary hypertension undergoing noncardiac surgery may also have impacted the results.

The study was unable to replicate the association between proportion of clinical time and anesthesia-related cardiac arrest. A multicentre study may be needed to address these questions.


Reviewed by: Dr Mei-Foong Yeoh