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Unanticipated admissions to paediatric cardiac critical care after cardiac catheterisations
Erin Peebles1, Michael R Miller2, Lee N Benson3
1Department of Pediatrics, Children's Hospital London Health Science Center,Western University,London,Canada.
Insights
Unplanned admissions to the cardiac critical care unit (CCCU) after pediatric cardiac catheterization are uncommon, primarily affecting young children undergoing interventional procedures. Outcomes were similar for planned and unplanned CCCU admissions.
Area of Science:
- Pediatric Cardiology
- Critical Care Medicine
- Interventional Cardiology
Background:
- Cardiac catheterization is a common diagnostic and therapeutic procedure in pediatric cardiology.
- The procedure carries inherent risks, sometimes leading to unexpected critical care admissions.
- Understanding the characteristics of these admissions is crucial for improving patient care.
Purpose of the Study:
- To describe the characteristics of children unexpectedly admitted to the cardiac critical care unit (CCCU) post-cardiac catheterization.
- To evaluate the outcomes of planned versus unplanned CCCU admissions following the procedure.
Main Methods:
- A retrospective, single-center review of cardiac catheterization procedures performed between January 2003 and April 2013.
- Analysis of 9336 procedures to identify admissions to the CCCU, categorizing them as planned or unexpected.
Main Results:
- 1.6% (146/9336) of procedures resulted in CCCU admission; 1.3% (117/9336) were unexpected.
- Unexpected admissions were more common in infants without comorbidities, often linked to interventional procedures or complications.
- Mechanical ventilation was the primary CCCU management; 90.6% of unexpected admissions survived to discharge.
Conclusions:
- CCCU admission post-cardiac catheterization is infrequent, predominantly in younger children undergoing interventions.
- Outcomes did not significantly differ between planned and unplanned CCCU admissions.
- Further research into risk stratification and the use of unplanned admissions as a quality indicator is warranted.
Objectives:
Cardiac catheterisation is commonly used for diagnosis and therapeutic interventions in paediatric cardiology. The inherent risk of the procedure can result in unanticipated admissions to critical care. Our goals were to provide a qualitative description of characteristics and evaluation of children admitted unexpectedly to the cardiac critical care unit (CCCU).
Methods:
A retrospective single centre review of cardiac catheterisation procedures was done between 1 January, 2003 and 30 April, 2013.
Results:
Of 9336 cardiac catheterisations performed, 146 (1.6%) were admitted from the catheterisation laboratory to the CCCU and met inclusion criteria. Of these 146 patients, 117 (1.3%) met criteria for unexpected admission and 29 (0.3%) were planned admissions. The majority admitted unexpectedly were below 1 year of age without co-morbidity aside from heart disease. Patients with planned admissions were significantly more likely to have single ventricle physiology, undergoing angiography or transferred for observation. Most unplanned admissions were triggered by interventional catheterisations or procedure-related complications. Patients received mechanical ventilation as the main CCCU management. Eighteen patients needed either cardiopulmonary resuscitation and/or extracorporeal membrane oxygenation during their catheterisation. About 106/117 (90.6%) patients survived to hospital discharge with no deaths in the planned admission group.
Conclusions:
Admission to CCCU following cardiac catheterisation was uncommon and tended to occur in younger children undergoing interventional procedures. Outcomes did not differ between patients experiencing planned and unplanned CCCU admission. Ongoing development of risk stratification tools may help to decrease unplanned CCCU admissions. Further studies are needed to determine whether unplanned admission following paediatric cardiac catheterisation should be utilised as a quality indicator.
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