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2. Incidence of severe critical events in paediatric anaesthesia (APRICOT): a prospective multicentre observational study in 261 hospitals in Europe

Author

Habre, Walid, Disma, Nicola, Virag, Katalin, Becke, Karin, Hansen, Tom G., Joehr, Martin, Leva, Brigitte, Morton, Neil S., Vermeulen, Petronella M., Zielinska, Marzena, Boda, Krisztina, Veyckemans, Francis, Klimscha, Walter, Konecny, Regina, Luntzer, Robert, Morawk-Wintersperger, Ulrike, Neiger, Franz, Rustemeyer, Lydia, Breschan, Christian, Frey, Denise, Platzer, Manuela, Germann, Reinhard, Oeding, Joachim, Stoegermuller, Birgit, Ziegler, Bernhard, Brotatsch, Philipp, Gutmann, Anton, Mausser, Gerlinde, Messerer, Brigitte, Toller, Wolfgang, Vittinghoff, Maria, Zangl, Gregor, Seidel-Ahyai, Natascha, Hochhold, Christoph, Kroess, Ruth, Paal, Peter, Cnudde, Steven, Coucke, Patricia, Loveniers, Birgit, Mitchell, John, Kahn, David, Pirotte, Thierry, Pregardien, Caroline, Coppens, Marc, De Baerdemaeker, Luc, De Hert, Stefan, Heyse, Bjorn, Neckebroek, Martine, Parashchanka, Aliaksandra, Van Limmen, Jurgen, Van Den Eynde, Nancy, Vanpeteghem, Caroline, Wyffels, Piet, Lalot, Michael, Lechat, Jean-Paul, Stevens, France, Casaer, Sari, De Groote, Francoise, De Pooter, Francoise, De Ville, Andree, Gerin, Marc, Magasich, Natalia, Torres, Cristel Sanchez, Van Deenen, Denise, Berghmans, Johan, Himpe, Dirk, Roofthooft, Eva, Joukes, Ellen, Smitz, Carine, Van Reeth, Veronique, Huygens, Christel, Lauweryns, Julie, De Smet, Karen, Najafi, Nadia, Poelaert, Jan, Van de Velde, Anne, Van Mossevelde, Veerle, Bekavac, Ivan, Butkovic, Diana, Litvic, Dubravka Heli, Soric, Ivana Kerovec, Maretic, Hrvoje, Moscatello, Djurdjica, Popovic, Ljiljana, Micic, Slobodan, Tus, Ivana Stuck, Fabris, Lada Kalagac, Simurina, Tatjana, Sulen, Nina, Kesi-Valpotic, Gordana, Djapic, Dajana, Zurek, Jiri, Jureckova, Lucie, Mackova, Iveta, Skacel, Monika, Weinlichova, Stanislava, Divak, Jan, Frelich, Michal, Urbanec, Rene, Biskupova, Vera, Mixa, Vladimir, Pavlickova, Jana, Afshari, Arash, Bottger, Morten, Ellekvist, Marguerite B., Johansen, Mathias, Madsen, Birgitte Ingeborg, Nilsson, Jens Christian, Schousboe, Birgitte M. B., Clausen, Nicola G., Steen, Nick Phaff, Ilmoja, Mari-Liis, Tonise, Virge, Karjagin, Juri, Kikas, Reet, Isohanni, Mika, Lyly, Anniina, Takala, Annika, Happo, Johanna, Kiviluoma, Kai, Martikainen, Kati, Aantaa, Riku, Manner, Tuula, Vilo, Sanna, Amory, Catherine, Ludot, Hugues, Lambotte, Patricia, Busche, Rene, Jacqmarcq, Olivier, Lejus, Corinne, Corouge, Julien, Erb, Christian, Garrigue, Delphine, Gillet, Patricia, Laffargue, Anne, Lambelin, Veronique, Le Freche, Helene, Peresbota, Daliana, Richart, Pierre, Berton, Jerome, Chapotte, Catherine, Colbus, Laurent, Lehousse, Thierry, Monrigal, Jean, Baujard, Catherine, Roulleau, Philippe, Staiti, Giuseppe, Batoz, Helene, Bordes, Maryline, Didier, Anne, Hamonic, Yann, Lagarde, Sylvaine, Nouette-Gaulain, Karine, Semjen, Francois, Zaghet, Brigitte, Dekens, Jacky, Delcuze, Axelle, Dupont, Herve, Legrand, Aurelien, Raffoflandreur, Celine, Audren, Noemie, Camus, Blandine, Cartal, Marielle, Chazelet, Chantal, Davin, Isabelle, Guillier, Marion, Desjeux, Luc, Larcher, Claire, Grein, Elodie, Leclercq, Mickeal, Levitchi, Roxana, Rosu, Lilica, Simon, Dominique, Zang, Aurelien, Migeon, Anne, Gagey, Anne-Charlotte, Bourdaud, Nathalie, Carre, Anne-Charlotte, Duflo, Frederic, Riche, Jean-Claude, Robert, Philippe, Druot, Emilie, Maupain, Olivier, Orliaguet, Gilles, Sabau, Lucie, Taright, Hanna, Uhrig, Lynn, Verchere-Montmayeur, Juliette, Debrabant, Lise, Pilla, Clotaire, Podvin, Alexandre, Roth, Benjamin, Dahmani, Souhayl, Julien-Marsollier, Florence, Sabourdin, Nada, Alexandri, Bogdan, Brezac, Gilles, de la Briere, Francois, Hayem, Catherine, Lhubat, Elizabeth, Mission, Jean Paul, Remond, Charlotte, Dadure, Christophe, Maniora, Maud, Marie, Anais, Pirat, Philippe, Saour, Anne-Charlotte, Sola, Chrystelle, Ecoffey, Claude, Wodey, Eric, Adam, Christian, Standl, Thomas, Schindler, Ehrenfried, Yamamoto, Tomohiro, Brackhahn, Michael, Eich, Christoph Bernhard, Guericke, Holger, Kindermann, Petra, Laschat, Michael, Schink, Cornel, Wappler, Frank, Hoehne, Claudia, Skordou, Natalia, Ulrici, Johanna, Jetzek-Zader, Martin, Kienbaum, Peter, Meyer-Treschan, Tanja, Picker, Olaf, Schaefer, Maximilian S., Mielke, Golo, Baethge, Sabine, Ramminger, Axel, Bauer, Martin, Bollinger, Matthias, Hinz, Jose, Quintel, Michael, Russo, Sebastian G., Bauer, Michael, Geil, Dfominik, Kortgen, Andreas, Preussler, Niels-Peter, Hofmann, Ulrich, Raber, Manfred, Reindl, Doris, Oppenrieder, Karin, Schierlinger, Bettina, Roth, Jens, Funk, Wolfgang, Fischer, Thomas, Gernoth, Christian, Wiefelsputz, Christina, Volger, Hauke, Zederer, Nicole, Diers, Anja, Huber, Matthias, Schorer, Clemens, Weyland, Andreas, Schwarzkopf, Konrad, Grau, Catharina, Roth, Winfried, Holy, Rolf, Mader, Thomas, Peter, Laura, Supthut, Hauke, Kuehhirt, Thomas, Milde, Alexander, Fiedler, Fritz, Isselhorst, Carsten, Grundmann, Ulrich, Pattar, Alexander, Reinert, Jennifer, Ehm, Birgit, Fritzsche, Katrin, Gaebler, Ralf, Meybohm, Patrick, Hein, Maximilian, Guzman, Ines, Jokinen, Johanna, Kranke, Peter, Goebel, Ulrich, Harris, Sarah, Eisner, Christoph, Ochsenreiter, Miriam, Schoeler, Michael, Thil, Elke, Ellerkmann, Richard, Hoeft, Andreas, Neumann, Claudia, Weber, Stefan, Keilhauer, Julia, Kloessing, Jan, Schramm, Michael, Trieschmann, Uwe, Knauss, Kristina, Sinner, Barbara, Steinmann, Johannes, Koessler, Herbert, Kalliardou, Evagelia, Malisiova, Anna, Tsiotou, Adelais, Chloropoulou, Pelagia, Chrysi, Mpratzou, Iordanidou, Despoina, Ntavlis, Merkourios, Rarosi, Ferenc, Boda, Krisztina B., Guerin, Christilynn, Irwin, Janice, Magner, Claire, Nakhjavani, Solmaz, O'Hare, Brendan, Galvin, Deborah, Jamil, Yosry, Lesmes, Carlos, Barak, Yuri, Fisher, Haran, Kachko, Ludmyla, Katz, Jacob, Kirilov, Dmitry, Levinzon, Michael, Manevich, Yair, Nekrasov, Konstantin, Peled, Elia, Sanko, Elena, Schmain, Dmitri, Sheinkin, Olga, Simhi, Eliahu, Tarabikin, Alex, Trabkin, Evelina, Yagudaev, Irena, Zeitlin, Yelena, Zunser, Igor, Habre, Walid, Disma, Nicola, Virag, Katalin, Becke, Karin, Hansen, Tom G., Joehr, Martin, Leva, Brigitte, Morton, Neil S., Vermeulen, Petronella M., Zielinska, Marzena, Boda, Krisztina, Veyckemans, Francis, Klimscha, Walter, Konecny, Regina, Luntzer, Robert, Morawk-Wintersperger, Ulrike, Neiger, Franz, Rustemeyer, Lydia, Breschan, Christian, Frey, Denise, Platzer, Manuela, Germann, Reinhard, Oeding, Joachim, Stoegermuller, Birgit, Ziegler, Bernhard, Brotatsch, Philipp, Gutmann, Anton, Mausser, Gerlinde, Messerer, Brigitte, Toller, Wolfgang, Vittinghoff, Maria, Zangl, Gregor, Seidel-Ahyai, Natascha, Hochhold, Christoph, Kroess, Ruth, Paal, Peter, Cnudde, Steven, Coucke, Patricia, Loveniers, Birgit, Mitchell, John, Kahn, David, Pirotte, Thierry, Pregardien, Caroline, Coppens, Marc, De Baerdemaeker, Luc, De Hert, Stefan, Heyse, Bjorn, Neckebroek, Martine, Parashchanka, Aliaksandra, Van Limmen, Jurgen, Van Den Eynde, Nancy, Vanpeteghem, Caroline, Wyffels, Piet, Lalot, Michael, Lechat, Jean-Paul, Stevens, France, Casaer, Sari, De Groote, Francoise, De Pooter, Francoise, De Ville, Andree, Gerin, Marc, Magasich, Natalia, Torres, Cristel Sanchez, Van Deenen, Denise, Berghmans, Johan, Himpe, Dirk, Roofthooft, Eva, Joukes, Ellen, Smitz, Carine, Van Reeth, Veronique, Huygens, Christel, Lauweryns, Julie, De Smet, Karen, Najafi, Nadia, Poelaert, Jan, Van de Velde, Anne, Van Mossevelde, Veerle, Bekavac, Ivan, Butkovic, Diana, Litvic, Dubravka Heli, Soric, Ivana Kerovec, Maretic, Hrvoje, Moscatello, Djurdjica, Popovic, Ljiljana, Micic, Slobodan, Tus, Ivana Stuck, Fabris, Lada Kalagac, Simurina, Tatjana, Sulen, Nina, Kesi-Valpotic, Gordana, Djapic, Dajana, Zurek, Jiri, Jureckova, Lucie, Mackova, Iveta, Skacel, Monika, Weinlichova, Stanislava, Divak, Jan, Frelich, Michal, Urbanec, Rene, Biskupova, Vera, Mixa, Vladimir, Pavlickova, Jana, Afshari, Arash, Bottger, Morten, Ellekvist, Marguerite B., Johansen, Mathias, Madsen, Birgitte Ingeborg, Nilsson, Jens Christian, Schousboe, Birgitte M. B., Clausen, Nicola G., Steen, Nick Phaff, Ilmoja, Mari-Liis, Tonise, Virge, Karjagin, Juri, Kikas, Reet, Isohanni, Mika, Lyly, Anniina, Takala, Annika, Happo, Johanna, Kiviluoma, Kai, Martikainen, Kati, Aantaa, Riku, Manner, Tuula, Vilo, Sanna, Amory, Catherine, Ludot, Hugues, Lambotte, Patricia, Busche, Rene, Jacqmarcq, Olivier, Lejus, Corinne, Corouge, Julien, Erb, Christian, Garrigue, Delphine, Gillet, Patricia, Laffargue, Anne, Lambelin, Veronique, Le Freche, Helene, Peresbota, Daliana, Richart, Pierre, Berton, Jerome, Chapotte, Catherine, Colbus, Laurent, Lehousse, Thierry, Monrigal, Jean, Baujard, Catherine, Roulleau, Philippe, Staiti, Giuseppe, Batoz, Helene, Bordes, Maryline, Didier, Anne, Hamonic, Yann, Lagarde, Sylvaine, Nouette-Gaulain, Karine, Semjen, Francois, Zaghet, Brigitte, Dekens, Jacky, Delcuze, Axelle, Dupont, Herve, Legrand, Aurelien, Raffoflandreur, Celine, Audren, Noemie, Camus, Blandine, Cartal, Marielle, Chazelet, Chantal, Davin, Isabelle, Guillier, Marion, Desjeux, Luc, Larcher, Claire, Grein, Elodie, Leclercq, Mickeal, Levitchi, Roxana, Rosu, Lilica, Simon, Dominique, Zang, Aurelien, Migeon, Anne, Gagey, Anne-Charlotte, Bourdaud, Nathalie, Carre, Anne-Charlotte, Duflo, Frederic, Riche, Jean-Claude, Robert, Philippe, Druot, Emilie, Maupain, Olivier, Orliaguet, Gilles, Sabau, Lucie, Taright, Hanna, Uhrig, Lynn, Verchere-Montmayeur, Juliette, Debrabant, Lise, Pilla, Clotaire, Podvin, Alexandre, Roth, Benjamin, Dahmani, Souhayl, Julien-Marsollier, Florence, Sabourdin, Nada, Alexandri, Bogdan, Brezac, Gilles, de la Briere, Francois, Hayem, Catherine, Lhubat, Elizabeth, Mission, Jean Paul, Remond, Charlotte, Dadure, Christophe, Maniora, Maud, Marie, Anais, Pirat, Philippe, Saour, Anne-Charlotte, Sola, Chrystelle, Ecoffey, Claude, Wodey, Eric, Adam, Christian, Standl, Thomas, Schindler, Ehrenfried, Yamamoto, Tomohiro, Brackhahn, Michael, Eich, Christoph Bernhard, Guericke, Holger, Kindermann, Petra, Laschat, Michael, Schink, Cornel, Wappler, Frank, Hoehne, Claudia, Skordou, Natalia, Ulrici, Johanna, Jetzek-Zader, Martin, Kienbaum, Peter, Meyer-Treschan, Tanja, Picker, Olaf, Schaefer, Maximilian S., Mielke, Golo, Baethge, Sabine, Ramminger, Axel, Bauer, Martin, Bollinger, Matthias, Hinz, Jose, Quintel, Michael, Russo, Sebastian G., Bauer, Michael, Geil, Dfominik, Kortgen, Andreas, Preussler, Niels-Peter, Hofmann, Ulrich, Raber, Manfred, Reindl, Doris, Oppenrieder, Karin, Schierlinger, Bettina, Roth, Jens, Funk, Wolfgang, Fischer, Thomas, Gernoth, Christian, Wiefelsputz, Christina, Volger, Hauke, Zederer, Nicole, Diers, Anja, Huber, Matthias, Schorer, Clemens, Weyland, Andreas, Schwarzkopf, Konrad, Grau, Catharina, Roth, Winfried, Holy, Rolf, Mader, Thomas, Peter, Laura, Supthut, Hauke, Kuehhirt, Thomas, Milde, Alexander, Fiedler, Fritz, Isselhorst, Carsten, Grundmann, Ulrich, Pattar, Alexander, Reinert, Jennifer, Ehm, Birgit, Fritzsche, Katrin, Gaebler, Ralf, Meybohm, Patrick, Hein, Maximilian, Guzman, Ines, Jokinen, Johanna, Kranke, Peter, Goebel, Ulrich, Harris, Sarah, Eisner, Christoph, Ochsenreiter, Miriam, Schoeler, Michael, Thil, Elke, Ellerkmann, Richard, Hoeft, Andreas, Neumann, Claudia, Weber, Stefan, Keilhauer, Julia, Kloessing, Jan, Schramm, Michael, Trieschmann, Uwe, Knauss, Kristina, Sinner, Barbara, Steinmann, Johannes, Koessler, Herbert, Kalliardou, Evagelia, Malisiova, Anna, Tsiotou, Adelais, Chloropoulou, Pelagia, Chrysi, Mpratzou, Iordanidou, Despoina, Ntavlis, Merkourios, Rarosi, Ferenc, Boda, Krisztina B., Guerin, Christilynn, Irwin, Janice, Magner, Claire, Nakhjavani, Solmaz, O'Hare, Brendan, Galvin, Deborah, Jamil, Yosry, Lesmes, Carlos, Barak, Yuri, Fisher, Haran, Kachko, Ludmyla, Katz, Jacob, Kirilov, Dmitry, Levinzon, Michael, Manevich, Yair, Nekrasov, Konstantin, Peled, Elia, Sanko, Elena, Schmain, Dmitri, Sheinkin, Olga, Simhi, Eliahu, Tarabikin, Alex, Trabkin, Evelina, Yagudaev, Irena, Zeitlin, Yelena, and Zunser, Igor

Abstract

Background Little is known about the incidence of severe critical events in children undergoing general anaesthesia in Europe. We aimed to identify the incidence, nature, and outcome of severe critical events in children undergoing anaesthesia, and the associated potential risk factors. Methods The APRICOT study was a prospective observational multicentre cohort study of children from birth to 15 years of age undergoing elective or urgent anaesthesia for diagnostic or surgical procedures. Children were eligible for inclusion during a 2-week period determined prospectively by each centre. There were 261 participating centres across 33 European countries. The primary endpoint was the occurence of perioperative severe critical events requiring immediate intervention. A severe critical event was defined as the occurrence of respiratory, cardiac, allergic, or neurological complications requiring immediate intervention and that led (or could have led) to major disability or death. This study is registered with ClinicalTrials.gov, number NCT01878760. Findings Between April 1, 2014, and Jan 31, 2015, 31 127 anaesthetic procedures in 30 874 children with a mean age of 6.35 years (SD 4.50) were included. The incidence of perioperative severe critical events was 5.2% (95% CI 5.0-5.5) with an incidence of respiratory critical events of 3.1% (2.9-3.3). Cardiovascular instability occurred in 1.9% (1.7-2.1), with an immediate poor outcome in 5.4% (3.7-7.5) of these cases. The all-cause 30-day in-hospital mortality rate was 10 in 10 000. This was independent of type of anaesthesia. Age (relative risk 0.88, 95% CI 0.86-0.90; p<0.0001), medical history, and physical condition (1.60, 1.40-1.82; p<0.0001) were the major risk factors for a serious critical event. Multivariate analysis revealed evidence for the beneficial effect of years of experience of the most senior anaesthesia team member (0.99, 0.981-0.997; p<0.0048 for respiratory critical events, and 0.98, 0.97-0.99; p=0.0039 for

Published
2017

5. Predictive Factors for Red Blood Cell Transfusion in Children Undergoing Noncomplex Cardiac Surgery.

Author

Mulaj, Muj, Faraoni, David, Willems, Ariane, Torres, Cristel Sanchez, and Van der Linden, Philippe

Abstract

Background Red blood cell (RBC) transfusion is frequently required in pediatric cardiac surgery and is associated with altered outcome and increased costs. Determining which factors predict transfusion in this context will enable clinicians to adopt strategies that will reduce the risk of RBC transfusion. This study aimed to assess predictive factors associated with RBC transfusion in children undergoing low-risk cardiac surgery with cardiopulmonary bypass (CPB). Methods Children undergoing surgery to repair ventricular septal defect or atrioventricular septal defect from 2006 to 2011 were included in this retrospective study. Demography, preoperative laboratory testing, intraoperative data, and RBC transfusion were reviewed. Univariate and multivariate logistic regression analysis were used to define factors that were able to predict RBC transfusion. Then, we employed receiver operating characteristic analysis to design a predictive score. Results Among the 334 children included, 261 (78%) were transfused. Age (< 18 months), priming volume of the CPB (> 43 mL/kg), type of oxygenator used, minimal temperature reached during CPB (< 32°C), and preoperative hematocrit (< 34%) were independently associated with RBC transfusion in the studied population. A predictive score 2 or greater was the best predictor of RBC transfusion. Conclusions The present study identified several factors that were significantly associated with perioperative RBC transfusion. Based on these factors, we designed a predictive score that can be used to develop a patient-based blood management program with the aim of reducing the incidence of RBC transfusion. [ABSTRACT FROM AUTHOR]

Published
2014
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