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Published on: July 18, 2014
Cardiac arrest in infants after congenital heart surgery
J F Rhodes1, A D Blaufox, H S Seiden
1Department of Pediatric Cardiology, The Mount Sinai Medical Center, New York, NY 10029, USA.
Insights
Infants surviving cardiac arrest after congenital heart surgery had better outcomes than other pediatric intensive care unit patients. Lower blood pressure and higher inotropic support before arrest indicated poorer survival chances.
Area of Science:
- Pediatric Cardiology
- Critical Care Medicine
- Congenital Heart Disease
Background:
- Survival rates after cardiac arrest in pediatric intensive care units (PICU) are critically low (7%).
- Specific survival rates and predictors for infants experiencing cardiac arrest post-congenital heart surgery remain largely unknown.
Purpose of the Study:
- To investigate the outcomes of infants who experienced cardiac arrest after congenital heart surgery.
- To identify potential predictors of survival in this specific patient population.
Main Methods:
- Retrospective analysis of infants in a PICU database who had postoperative cardiac arrest between January 1994 and June 1998.
- Analysis of perioperative, pre-arrest, and resuscitation parameters, comparing survivors and nonsurvivors.
Main Results:
- Of 575 infants undergoing congenital heart surgery, 34 (6%) had cardiac arrest, with 14 (41%) surviving to discharge.
- Lower pre-arrest blood pressure and higher pre-arrest inotropic support were associated with increased mortality.
- Survivors had shorter resuscitation durations, higher minimal arterial pH, and received less medication during resuscitation.
Conclusions:
- Infants with cardiac arrest post-congenital heart surgery have a better survival rate than general PICU populations.
- Hemodynamic compromise (low blood pressure, high inotropic support) pre-arrest predicts poorer outcomes.
- Fixed resuscitation endpoints may not be appropriate for this subgroup.
Background:
The survival rate to discharge after a cardiac arrest in a patient in the pediatric intensive care unit is reported to be as low as 7%. The survival rates and markers for survival strictly regarding infants with cardiac arrest after congenital heart surgery are unknown.
Methods And Results:
Infants in our pediatric cardiac intensive care unit database were identified who had a postoperative cardiac arrest between January 1994 and June 1998. Parameters from the perioperative, prearrest, and resuscitation periods were analyzed for these patients. Comparisons were made between survivors and nonsurvivors. Of 575 infants who underwent congenital heart surgery, 34 (6%) sustained a documented cardiac arrest; of these, 14 (41%) survived to discharge. Perioperative parameters, ventricular physiology, and primary rhythm at the time of arrest did not influence outcome. Prearrest blood pressure was lower in nonsurvivors than in survivors (P<0.001). A high level of inotropic support prearrest was associated with death (P=0.06). Survivors had a shorter duration of resuscitation (P<0.001) and higher minimal arterial pH (P<0.02) and received a smaller total dose of medication during the resuscitation. Although survivors had an overall shorter duration of resuscitation, 5 of 22 patients (23%) survived to discharge despite resuscitation of >30 minutes.
Conclusions:
The outcome of cardiac arrest in infants after congenital heart surgery was better than that for pediatric intensive care unit populations as a whole. Univentricular physiology did not increase the risk of death after cardiac arrest. Infants with more hemodynamic compromise before the arrest as demonstrated with lower mean arterial blood pressure and higher inotropic support were less likely to survive. The use of predetermined resuscitation end points in this subpopulation may not be justified.
