Intraoperative cardiopulmonary arrest in children undergoing spinal deformity correction

Emmanuel N. Menga, Cole Hirschfeld, Amit Jain, Dong Phuong Tran, Heather D. Caine, Dolores B. Njoku, Lori A. Karol, Paul D. Sponseller

Research output: Contribution to journalReview articlepeer-review

10 Scopus citations


Study Design. Retrospective review. Objective. To report the incidence of and risk factors for intraoperative cardiopulmonary arrest (ICA) in children undergoing spinal deformity surgery. Summary of Background Data. Spinal deformities in children are associated with comorbidities that can pose substantial risks during surgery. Methods. We reviewed records of patients who underwent surgery at two pediatric tertiary-care hospitals from 2004 through 2014. Fisher exact test and the Student t test were used to compare ICA and non-ICA groups by patient diagnosis, estimated blood loss, number of vertebral levels fused, and proportion of blood volume lost (significance, P<0.05). We classified proximate causes of ICA based on hemoglobin, metabolic panel/electrolyte imbalance, electrocardiogram/echocardiography, and vital signs. Results. ICA occurred in 11 of 2524 (0.4%) patients. Patients with neuromuscular disorders had a 3-fold higher risk of ICA compared with those without neuromuscular disorders. At the time of ICA, hemoglobin levels were 5g/dL or less in four patients, potassium was higher than 5.5mEq/L in six patients, and ionized calcium was less than or equal to 1mmol/L in two patients. There were significant differences between the ICA and non-ICA groups in mean number of vertebral levels fused (15 vs. 12), patient weight (34 vs. 49kg), estimated blood loss (2623 vs. 959mL), and proportion of blood volume lost (1.03 vs. 0.33) (all P<0.01). Suspected causes of ICA were cardiovascular causes (eight patients) and anaphylaxis, primary rhythm disturbance, and respiratory/airway cause (one patient each). The incidence of ICA for patients with idiopathic scoliosis was 0.13%. Ten of the 11 patients were successfully resuscitated, and one patient died. Conclusion. ICA occurs in approximately 0.4% of children undergoing spinal fusion surgery. Patients with neuromuscular disorders are at greater risk of ICA than those without these disorders.

Original languageEnglish
Pages (from-to)1757-1762
Number of pages6
Issue number22
StatePublished - Nov 1 2015


  • blood loss
  • cardiopulmonary resuscitation
  • electrolyte imbalance
  • intraoperative cardiopulmonary arrest
  • spinal deformity


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