Citation

Morray JP: Pediatric Perioperative Cardiac Arrest Registry. ASA Newsletter 59(6):13, 1995.

Full Text

The Pediatric Perioperative Cardiac Arrest (POCA) Registry was formed in April, 1994, under the combined auspices of the ASA Committee on Professional Liability and the Quality Assurance Committee of the American Academy of Pediatrics Section on Anesthesiology. The need for such a data collection mechanism became apparent during analysis of the pediatric claims in the ASA Closed Claims database.

As compared to the adult data, there were a high number of cardiac arrests and adverse outcomes in the pediatric claims that the reviewers attributed to inadequate ventilation.¹ The specific etiology of many of these cardiac arrests could not be determined. The POCA Registry will afford the opportunity for an in-depth examination of this phenomenon and also will provide denominator data (i.e., incidence) that is not available from the Closed Claims Project.

All cardiac arrests, defined as the need for cardiopulmonary resuscitation (CPR) during induction or maintenance of anesthesia or in the postanesthesia care unit in children 18 years of age or younger, are eligible for inclusion. For each case that qualifies, participating institutions are asked to fill out and submit a standardized data form to the data bank maintained by the University of Washington Department of Anesthesiology as a component of the Closed Claims Project. Anonymity is maintained so that neither patient, physician nor submitting institution can be identified.

As of February 1995, there are 32 institutions participating in the POCA Registry. Thirty of these are university-affiliated hospitals and 20 are pediatric hospitals. These 32 institutions administered more than 219,000 anesthetics in 1993. To date, 54 cases have been submitted to the POCA Registry. While approximately three-fourths of cases submitted involved ASA III or IV patients, one-fourth were ASAI or II patients undergoing elective surgery. Preoperative medical condition was a major factor contributing to cardiac arrest in the ASA III and IV patients. The most common causes of cardiac arrest were classified as cardiovascular.

Members of the Registry Steering Committee include: Robert A. Caplan, M.D., Frederick W. Cheney, M.D., Karen B. Domino, M.D., Jeremy M. Geiduschek, M.D., Alvin Hackel, M.D., Karen L. Posner, Ph.D., Chandra Ramamoorthy, M.D. and Jeffrey P. Morray, M.D., Registry Director.

The Steering Committee plans to increase the size of the Registry as well as the participation of community-based hospitals. All university-affiliated and community-based anesthesiology departments that care for children are encouraged to participate in the POCA Registry.

All necessary information can be obtained by contacting the POCA Registry in care of: Karen L. Posner, Ph.D., Department of Anesthesiology, Box 356540, Seattle, Washington 98195-6540; telephone: (206) 616-2673; e-mail: posner@u.washington.edu.

Reference

1. Morray JP, Geiduschek JM, Caplan RA, Posner KL, Gild WM, Cheney FW. A comparison of pediatric and adult anesthesia closed malpractice claims. Anesthesiology. 1993; 78:461-467. [Abstract]