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Cardiopulmonary Resuscitation in the Pediatric Cardiac Catheterization Laboratory: A Report From the American Heart
Javier J Lasa1, Alexander Alali2, Charles G Minard3
1Divisions of Critical Care Medicine and Cardiology, Texas Children's Hospital, Baylor College of Medicine, Houston, TX.
Insights
Most children with heart disease survive cardiac arrest in the cardiac catheterization lab. However, infants and those with metabolic issues face higher mortality risks, highlighting the need for targeted interventions.
Area of Science:
- Pediatric Cardiology
- Critical Care Medicine
- Clinical Research
Background:
- Hospitalized children with heart conditions are vulnerable to cardiac arrest during invasive procedures.
- Outcomes for pediatric cardiac arrest in cardiac catheterization labs are poorly documented.
Purpose of the Study:
- To determine survival rates for children experiencing cardiac arrest in the cardiac catheterization laboratory.
- To identify risk factors associated with hospital mortality after these events.
Main Methods:
- Retrospective analysis of a multicenter cardiac arrest registry (November 2005 - November 2016).
- Included pediatric patients (<18 years) with in-hospital cardiac arrest during catheterization.
- Analyzed survival to discharge using generalized estimating equations, considering age, illness category, comorbidities, and interventions.
Main Results:
- Overall survival to discharge was 69% (141/203) for pediatric patients experiencing cardiac arrest in the catheterization lab.
- Infants (<1 year) accounted for the majority of deaths (69%).
- Preexisting metabolic/electrolyte abnormalities, need for vasoactive infusions, and calcium product use were linked to lower survival rates.
Conclusions:
- A majority of children survive cardiac arrest in the cardiac catheterization laboratory.
- No significant survival difference was noted between surgical and medical cardiac patients.
- Further research is needed to stratify risks based on medical complexity and procedural factors.
Objectives:
Hospitalized children with underlying heart disease are at high risk for cardiac arrest, particularly when they undergo invasive catheterization procedures for diagnostic and therapeutic interventions. Outcomes for children experiencing cardiac arrest in the cardiac catheterization laboratory remain under-reported with few studies reporting survival beyond the catheterization laboratory. We aim to describe survival outcomes after cardiac arrest in the cardiac catheterization laboratory while identifying risk factors associated with hospital mortality after these events.
Design:
Retrospective observational study of data from a multicenter cardiac arrest registry from November 2005 to November 2016. Cardiac arrest in the cardiac catheterization laboratory was defined as the need for chest compressions greater than or equal to 1 minute in the cardiac catheterization laboratory. Primary outcome was survival to discharge. Variables analyzed using generalized estimating equations for association with survival included age, illness category (surgical cardiac, medical cardiac), preexisting conditions, pharmacologic interventions, and event duration.
Setting:
American Heart Association's Get With the Guidelines-Resuscitation registry of in-hospital cardiac arrest.
Patients:
Consecutive patients less than 18 years old experiencing an index (i.e., first) cardiac arrest event reported to the Get With the Guidelines-Resuscitation.
Interventions:
None.
Measurements And Main Results:
A total of 203 patients met definition of index cardiac arrest in the cardiac catheterization laboratory composed primarily of surgical and medical cardiac patients (54% and 41%, respectively). Children less than 1 year old comprised the majority of patients, 58% (117/203). Overall survival to hospital discharge was 69% (141/203). No differences in survival were observed between surgical and medical cardiac patients (p = 0.15). The majority of deaths (69%, 43/62) occurred in patients less than 1 year old. Bradycardia (with pulse) followed by pulseless electrical activity/asystole were the most common first documented rhythms observed (50% and 27%, respectively). Preexisting metabolic/electrolyte abnormalities (p = 0.02), need for vasoactive infusions (p = 0.03) prior to arrest, and use of calcium products (p = 0.005) were found to be significantly associated with lower rates of survival to discharge on multivariable regression.
Conclusions:
The majority of children experiencing cardiac arrest in the cardiac catheterization laboratory in this large multicenter registry analysis survived to hospital discharge, with no observable difference in outcomes between surgical and medical cardiac patients. Future investigations that focus on stratifying medical complexity in addition to procedural characteristics at the time of catheterization are needed to better identify risks for mortality after cardiac arrest in the cardiac catheterization laboratory.