全球儿童全麻相关心搏骤停率：系统评价和荟萃分析。

Global anaesthesia-related cardiac arrest rates in children: a systematic review and meta-analysis.

机构信息

Anaesthesia Cardiac Arrest and Mortality Study Commission, Department of Surgical Specialties and Anaesthesiology, Botucatu Medical School, Sao Paulo State University - UNESP, Botucatu, Sao Paulo, Brazil.

General Intensive Care Unit of the Shaare Zedek Medical Centre, Jerusalem, Israel; Hebrew University Faculty of Medicine, Jerusalem, Israel.

出版信息

Br J Anaesth. 2023 Nov;131(5):901-913. doi: 10.1016/j.bja.2023.08.023. Epub 2023 Sep 22.

DOI:10.1016/j.bja.2023.08.023

PMID:37743151

Abstract

BACKGROUND

Neonates and infants have a higher perioperative risk of cardiac arrest and mortality than adults. The Human Development Index (HDI) ranges from 0 to 1, representing the lowest and highest levels of development, respectively. The relation between anaesthesia safety and country HDI has been described previously. We examined the relationship among the anaesthesia-related cardiac arrest rate (ARCAR), country HDI, and time in a mixed paediatric patient population.

METHODS

Electronic databases were searched up to July 2022 for studies reporting 24-h postoperative ARCARs in children. ARCARs (per 10,000 anaesthetic procedures) were analysed in low-HDI (HDI<0.8) vs high-HDI countries (HDI≥0.8) and over time (pre-2001 vs 2001-22). The magnitude of these associations was studied using systematic review methods with meta-regression analysis and meta-analysis.

RESULTS

We included 38 studies with 5,493,489 anaesthetic procedures and 1001 anaesthesia-related cardiac arrests. ARCARs were inversely correlated with country HDI (P<0.0001) but were not correlated with time (P=0.82). ARCARs did not change between the periods in either high-HDI or low-HDI countries (P=0.71 and P=0.62, respectively), but were higher in low-HDI countries than in high-HDI countries (9.6 vs 2.0; P<0.0001) in 2001-22. ARCARs were higher in children aged <1 yr than in those ≥1 yr in high-HDI (10.69 vs 1.48; odds ratio [OR] 8.03, 95% confidence interval [CI] 5.96-10.81; P<0.0001) and low-HDI countries (36.02 vs 2.86; OR 7.32, 95% CI 3.48-15.39; P<0.0001) in 2001-22.

CONCLUSIONS

The high and alarming anaesthesia-related cardiac arrest rates among children younger than 1 yr of age in high-HDI and low-HDI countries, respectively, reflect an ongoing challenge for anaesthesiologists.

SYSTEMATIC REVIEW PROTOCOL

PROSPERO CRD42021229919.

摘要

背景

新生儿和婴儿在围手术期的心脏骤停和死亡率风险高于成人。人类发展指数（HDI）的范围为 0 到 1，分别代表最低和最高的发展水平。麻醉安全性与国家人类发展指数之间的关系此前已有描述。我们研究了小儿混合患者人群中麻醉相关心脏骤停率（ARAR）、国家人类发展指数和时间之间的关系。

方法

截至 2022 年 7 月，我们在电子数据库中检索了报告儿童 24 小时术后 ARAR 的研究。分析了低人类发展指数（HDI<0.8）与高人类发展指数（HDI≥0.8）国家之间（每 10000 次麻醉操作）的 ARCAR，并分析了 2001 年之前与 2001-22 年期间的 ARCAR。使用系统评价方法进行 meta 回归分析和 meta 分析来研究这些关联的大小。

结果

我们纳入了 38 项研究，共涉及 5493489 次麻醉操作和 1001 例麻醉相关心脏骤停。ARAR 与国家人类发展指数呈负相关（P<0.0001），但与时间无关（P=0.82）。在高人类发展指数或低人类发展指数国家，无论是在 2001-22 年期间，ARCAR 均未发生变化（分别为 P=0.71 和 P=0.62），但在 2001-22 年低人类发展指数国家的 ARCAR 高于高人类发展指数国家（9.6 比 2.0；P<0.0001）。在 2001-22 年，高人类发展指数国家和低人类发展指数国家中年龄<1 岁的儿童的 ARCAR 高于≥1 岁的儿童（分别为 10.69 比 1.48；优势比[OR]8.03，95%置信区间[CI]5.96-10.81；P<0.0001 和 36.02 比 2.86；OR 7.32，95% CI 3.48-15.39；P<0.0001）。