• Andreas Hohn, Uwe Trieschmann, Jeremy Franklin, Jan-Nicolas Machatschek, Jost Kaufmann, Holger Herff, Jochen Hinkelbein, Thorsten Annecke, Bernd W Böttiger, and Stephan A Padosch.
• 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 1; 36 (1): 55-63.

BackgroundPeri-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.ObjectiveThe current study analysed incidences of peri-operative paediatric cardiac arrest before and after implementation of a specialised paediatric anaesthesia team and training programme.DesignRetrospective cohort study with before-and-after analysis.SettingDepartment of Anaesthesiology and Intensive Care Medicine, University Hospital of Cologne, Germany.PatientsA total of 36 243 paediatric anaesthetics (0 to 18 years) were administered between 2008 and 2016.InterventionImplementation 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 MeasuresIncidences of peri-operative paediatric cardiac arrest and anaesthesia-attributable cardiac arrest before and after the intervention.ResultsTwelve 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.ConclusionIn 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.

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