From the Department of Anaesthesiology and Intensive Care Medicine, University Hospital of Cologne (AH, UT, HH, JH, TA, BWB, SAP), Institute of Medical Statistics and Computational Biology (IMSB), University of Cologne, Cologne (JF), Department of Anaesthesiology and Intensive Care Medicine, Marienhospital Brühl GmbH, Brühl (J-NM), Department of Paediatric Anaesthesia, Children's Hospital Cologne, Cologne (JK) and Faculty for Health, University of Witten/Herdecke, Witten, Germany (JK).
Eur J Anaesthesiol. 2019 Jan;36(1):55-63. doi: 10.1097/EJA.0000000000000863.
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.
The current study analysed incidences of peri-operative paediatric cardiac arrest before and after implementation of a specialised paediatric anaesthesia team and training programme.
Retrospective cohort study with before-and-after analysis.
Department of Anaesthesiology and Intensive Care Medicine, University Hospital of Cologne, Germany.
A total of 36 243 paediatric anaesthetics (0 to 18 years) were administered between 2008 and 2016.
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.
Incidences of peri-operative paediatric cardiac arrest and anaesthesia-attributable cardiac arrest before and after the intervention.
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.
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.
围手术期危急事件仍然是小儿麻醉护理中的一个主要问题。获得更有经验的医疗团队可能会降低不良事件发生率并改善结果。
本研究分析了专门的小儿麻醉团队和培训计划实施前后小儿心脏骤停的围手术期发生率。
回顾性队列研究，采用前后分析。
德国科隆大学医院麻醉学和重症监护医学系。
2008 年至 2016 年期间共进行了 36243 例小儿麻醉（0 至 18 岁）。
2014 年实施了专门的小儿麻醉团队和培训计划。这包括在小儿麻醉的所有领域进行实践监督培训、对危急儿科病例进行双人配备以及 24/7 应急小组。使用逻辑回归分析（危险因素：年龄、ASA 身体状况、紧急情况）来评估专门的小儿麻醉团队实施的影响。
围手术期小儿心脏骤停和麻醉相关心脏骤停的发生率。
25 例小儿心脏骤停中有 12 例被归类为麻醉相关。2008 年至 2013 年期间，整体围手术期小儿心脏骤停发生率为 8.1/10000（95%CI 5.2 至 12.7），2014 年至 2016 年降至 4.6/10000（95%CI 2.1 至 10.2）。同样，2013 年后麻醉相关心脏骤停的发生率较低[1.6/10000（95%CI 0.3 至 5.7）与 4.3/10000（95%CI 2.3 至 7.9）]。使用逻辑回归，2013 年后接受麻醉的儿童麻醉相关心脏骤停的可能性降低近 70%（比值比 0.306，95%CI 0.067 至 1.397；P=0.1263）。对于麻醉相关心脏骤停，年龄较小是最主要的危险因素，而在整体小儿心脏骤停中，ASA 身体状况 3 至 5 发挥了更重要的作用。
在这项来自欧洲三级护理大学医院的围手术期小儿心脏骤停发生率研究中，专门的小儿麻醉团队和培训计划的实施与围手术期小儿心脏骤停发生率降低和麻醉相关心脏骤停的可能性降低相关。
