Neuromuscular Disorders May Increase Risk Of Cardiac Arrest During Pediatric Spine Surgery

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While overall risk remained low, children with neuromuscular disorders were 3 times more likely to suffer from cardiac arrest during spine surgeries.
While overall risk remained low, children with neuromuscular disorders were 3 times more likely to suffer from cardiac arrest during spine surgeries.

Even though most pediatric spine surgeries are considered to be relatively safe, some neuromuscular disorders may put children at risk for cardiac arrest during these operations, according to research published in the journal Spine.

While the overall risk remains very low, this additional knowledge could help clinicians with preparing children who have recognized risk factors for surgery. “Our findings are reassuring: spinal surgeries in children are overwhelmingly safe, but even so, some risk remains,” said Paul Sponseller, MD, MBA, director of Pediatric Orthopaedics at the Johns Hopkins Children's Center in a statement. “Armed with this knowledge, surgeons can plan accordingly by taking a few additional preventive steps to make what is an already safe surgery even safer.”

To pinpoint factors that might increase children's risk for cardiac arrest during spine surgeries, researchers reviewed records of 2524 pediatric spinal surgeries performed at the Johns Hopkins Children's Center and Texas Scottish Rite Hospital for Children in Dallas between 2004 and 2014.

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While the researchers emphasized that the overall risk remains very low — out of the 2524 patients, 11 of the children had cardiac arrest during surgery and 1 died —  the results showed that children with neuromuscular disorders such as cerebral palsy, spina bifida, and muscular dystrophy were 3 times more likely to suffer cardiac arrest. Out of the 11 children who suffered cardiac arrest, 6 had a neuromuscular disorder.

In 8 out of the 11 patients, the researchers determined that cardiac arrest was triggered by electrolyte or circulatory problems. This is not surprising, the researchers noted, given that children tend to develop electrolyte imbalance more quickly than adults, and have less blood and lower blood pressure, making them more vulnerable to circulatory shock. Other causes of cardiac arrest included allergic anaphylaxis, irregular heartbeat, and respiratory and airway problems.

While most children with scoliosis have mild forms of the condition and do not need corrective surgery, those with forms of scoliosis tied to neuromuscular disease tend to have more severe spinal curvatures and need surgery at a younger age, making them more vulnerable to the effects of surgery and anesthesia and putting them at a higher risk for serious complications.

While many causes of cardiac arrest in these situations are not preventable, the knowledge from this study could help doctors determine who is at risk. Understanding who fits this criteria could improve how doctors prepare for these surgeries, cut response times in an emergency, and reduce stress if a complication should arise.

“Our findings underscore the notion that any surgery can escalate from routine to super-stressful in a matter of seconds,” said Dr. Sponseller. “We are hypervigilant during all surgeries, but at the same time, knowing which patients are most likely to decompensate is always a good thing.”

Reference

Menga EN, Hirschfeld C, Jain A, et al. Intraoperative Cardiopulmonary Arrest in Children Undergoing Spinal Deformity Correction: Causes and Factors. Spine J. 2015; doi:10.1097/BRS.0000000000001105.

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