Paediatric anaesthesia in Europe: the APRICOT study

Paediatric anaesthesia in Europe: the APRICOT study

  • Issue 70

One of the sessions on the final day of this year’s Euroanaesthesia meeting was dedicated to another successful study from the ESA’s Clinical Trials Network (CTN) – the APRICOT study.

On 28 March 2017, APRICOT (Anaesthesia PRactice In Children Observational Trial) was published in The Lancet Respiratory Medicine. The primary endpoint of this trial was incidence of severe critical events, defined by incidents occurring during and up to 60 minutes after anaesthesia or sedation (laryngospasm, bronchospasm, pulmonary aspiration, drug error, anaphylaxis, cardiovascular instability, neurological damage, cardiac arrest and post-extubation stridor) during and immediately following anaesthesia (PACU).

APRICOT showed that the overall incidence of severe critical events associated with anaesthesia is higher than previously believed, with a large variability among the participating centres across Europe. Children from birth to 15 years of age undergoing elective or urgent anaesthesia for diagnostic or surgical procedures were included. With more than 260 participating centres across 33 countries and comprising more than 31,000 anaesthetic procedures, APRICOT is the largest database on paediatric anaesthesia in Europe.

The results of the study provide insight into the paediatric anaesthesia practice across     Europe and the incidence, nature and outcome of severe critical events associated with anaesthesia. The occurrence of of respiratory, cardiac, allergic or neurological complications requiring immediate intervention that led or may have led to major disability and/or death was recorded in detail.

“What is both surprising and concerning is that more than 5% of children undergoing anaesthesia in our study experienced at least one severe critical event. In 17% of them additional anaesthesia treatments, prolonged treatment in hospital, or both were needed.,” said Professor Walid Habre, APRICOT Lead Investigator. “Our findings reinforce the urgent need to elaborate and implement standardised training programmes and good clinical practice guidelines for paediatric anaesthesia management throughout Europe.”

The APRICOT study showed startling differences in severe critical events among European countries with a 20 to 30 times variation in incidence. Many factors are involved, but there was statistical evidence that experienced paediatric anaesthesiologists and teams with a higher volume of paediatric patients had significantly fewer severe critical events. The results suggest children less than 3 years of age should be managed by more experienced teams with specific paediatric training and support.

There will also be a presentation on APRICOT in September in Glasgow at the annual congress of the European Society for Paediatric Anaesthesiology.

For more information on the APRICOT study:
http://www.esahq.org/apricot

To view the abstract of the published study:http://www.thelancet.com/journals/lanres/article/PIIS2213-2600(17)30116-9/fulltext