Children with certain neuromuscular disorders three times more likely to experience cardiac arrest during spinal surgery


The risk of cardiac arrest during spinal surgery seems to be greater in children with certain neuromuscular disorders, according to research from the Johns Hopkins Children Center.

The journal, Spine, will publish a report on the findings, which is believed to be the first to quantify the risk of cardiac arrest during spinal surgery in children. The researchers believe that this information can help surgeons and operating room staff better plan for such events in high-risk patients.

The study results stem from an analysis of outcomes in some 2,600 spinal surgeries performed at the Johns Hopkins Children’s Center and Texas Scottish Rite Hospital for Children in Dallas between 2004 and 2014.

The authors point out that the absolute risk of cardiac arrest in children during spine surgery is very small. Of the 2,639 patients in the study, 11 experienced the complication. One patient died. Ten of the 11 children were successfully resuscitated.

The results showed that children with such neuromuscular disorders as cerebral palsy, spina bifida, and muscular dystrophy, were three times more likely to suffer cardiac arrest during surgeries that straighten the spine. Six of the 11 children who had a cardiac arrest had a neuromuscular disorder.

In eight of the 11 cases, cardiac arrest was triggered by electrolyte imbalances or circulatory problems.

“Our findings are reassuring: spinal surgeries in children are overwhelmingly safe, but even so, some risk remains,” says lead investigator Paul Sponseller, director of paediatric orthopaedics at the Johns Hopkins Children’s Center.

Sponseller and colleagues say that while many of the factors that lead to cardiac arrest in these cases are not preventable, knowing who is at highest risk can improve preparedness, cut response time and reduce stress among the surgical staff should a complication occur.

“Our findings underscore the notion that any surgery can escalate from routine to super-stressful in a matter of seconds,” says 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.”