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Published on: September 11, 2011
Contrast administration in pediatric cardiac catheterization: dose and adverse events
Selvi Senthilnathan1, Kimberlee Gauvreau, Audrey C Marshall
1Department of Pediatrics, Children's Hospital at Dartmouth, Lebanon, New Hampshire, USA.
Insights
Adverse events (AE) from contrast during pediatric cardiac catheterization are rare, even with high doses. This study found only 0.09% of cases had possible contrast-related AE, highlighting the safety of contrast administration.
Area of Science:
- Pediatric Cardiology
- Interventional Cardiology
- Medical Imaging
Background:
- Contrast media administration in pediatric cardiac catheterization can lead to adverse events (AE), including allergic reactions, seizures, and nephropathy.
- The precise incidence of these contrast-related AE in pediatric patients undergoing cardiac catheterization remains largely unknown.
Purpose of the Study:
- To determine the rates of adverse events (AE) attributed to contrast administration in a pediatric cardiac catheterization laboratory.
- To identify patient and procedural characteristics associated with higher contrast doses during these procedures.
Main Methods:
- A prospective database of cardiac catheterization AE was utilized, focusing on patients under 18 years old exposed to contrast media.
- AE were reviewed and classified by their relationship to contrast. A retrospective review of medical records for the highest contrast dose recipients was also performed.
- Patient and procedural factors were compared between the top quartile of contrast dose and the remaining cases.
Main Results:
- Over three years, 2,321 cases involved contrast administration, with a median dose of 3.9 cm³/kg.
- Patients receiving high contrast doses (top quartile) were more likely to be younger, weigh less, have complex congenital heart disease, and undergo longer procedures (all P < 0.001).
- Only 2 out of 2,321 cases (0.09%) experienced AE possibly related to contrast (neurological change, transient nephropathy). No AE were attributed to contrast in the highest dose group.
Conclusions:
- A significant proportion of pediatric cardiac catheterization cases at a high-volume center utilize high contrast doses (≥ 6 cm³/kg).
- Despite high contrast volumes, AE directly related to contrast exposure were exceedingly rare in this pediatric population.
- The findings support the safety of contrast administration in pediatric cardiac catheterization, even at higher volumes.
Background:
In pediatrics, contrast-related AE such as allergic reactions, seizures, and nephropathy have been reported to occur after cardiac catheterization, but their incidence remains unknown.
Objective:
We sought to report adverse event (AE) rates attributed to contrast administration in a pediatric cardiac catheterization lab and identify characteristics related to higher doses.
Methods:
A single institution prospective cardiac catheterization AE database identified AE in children <18 years old exposed to contrast. All AE were reviewed and classified by relationship to contrast. Medical records for the 50 cases who received highest contrast doses were retrospectively reviewed for AE. Patient and procedural characteristics were compared in the top quartile of contrast dose versus remaining cases.
Results:
Over 3 years, 2,321 consecutive cases required median 3.9 cm(3)/kg [IQR: 2.0, 6.0] of contrast. Patients receiving high dose contrast (top quartile) were more likely to be <1 year (51% vs. 24%), weigh <10 kg (66% vs. 29%), have complex 2 ventricle disease (56% vs. 35%), be in a high procedure type risk group (57% vs. 26%), and undergo procedures >2 h (67% vs. 28%), all P < 0.001. Only 2 of 2,321 cases (0.09%, 95% CI 0.01-0.31%) had AE possibly related to contrast. These events were an acute neurological change and transient nephropathy. In 50 cases receiving the most contrast, no AE were attributed to contrast.
Conclusion:
A large volume pediatric cardiac catheterization lab administered >or= 6 cm(3)/kg of contrast in a quarter of cases; however, AE related to contrast exposure were exceedingly rare.
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