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Adverse Events in the Pediatric Cardiac Catheterization Suite: Does Having Pediatric Cardiac Anesthesiologists Make a
Albert Y Lin1, Anthony Habib1, Riva Ko1
1Departments of Anesthesiology.
Insights
Pediatric cardiac catheterization adverse events were similar whether anesthesiologists specialized in cardiac care or not. This study found no significant difference in patient safety outcomes.
Area of Science:
- Anesthesiology
- Pediatric Cardiology
Background:
- Subspecialty expertise in pediatric cardiac anesthesia is often considered essential for managing complex congenital heart anomalies.
- The pediatric cardiac catheterization lab presents unique physiological challenges for anesthesia providers.
Purpose of the Study:
- To compare the incidence of adverse events in the pediatric cardiac catheterization lab.
- To evaluate whether care provided by cardiac versus noncardiac pediatric attending anesthesiologists impacts patient safety.
Main Methods:
- A retrospective analysis of 3,761 anesthetics in the pediatric cardiac catheterization lab from 2016-2019.
- Generalized linear mixed effect models were used to assess the association between anesthesiologist type and adverse events.
- Adjustments were made for patient age, ASA physical status, emergency status, and procedure type.
Main Results:
- No statistically significant difference in overall adverse events was found between cardiac and noncardiac attending anesthesiologists (OR, 1.2; 95% CI, 0.82 to 1.75).
- Specific respiratory adverse events (OR, 1.22; 95% CI, 0.73 to 2.03) and cardiac adverse events (OR, 1.26; 95% CI, 0.64 to 2.48) also showed no significant difference.
- The study included 1,729 patients undergoing procedures.
Conclusions:
- Anesthesia care by either cardiac or noncardiac attending anesthesiologists resulted in comparable incidences of adverse events in the pediatric cardiac catheterization lab.
- These findings suggest that specialized training may not be a significant factor in preventing adverse events in this setting.
Introduction:
It has been suggested that anesthesiologists with subspecialty expertise in pediatric cardiac anesthesia are best qualified to care for patients with complex congenital cardiac anomalies and manage the complex physiology frequently encountered in the pediatric cardiac catheterization lab. We evaluated the incidence of adverse events in our pediatric cardiac catheterization lab, comparing care provided by cardiac and noncardiac pediatric attending anesthesiologists.
Methods:
Data were collected on each anesthetic in the pediatric cardiac catheterization lab from January 1, 2016 to December 31, 2019. A generalized linear mixed effect model was used to identify associations between pediatric cardiac and noncardiac anesthesiologists and the presence of adverse events adjusting for age, American Society of Anesthesiologists physical status, emergency status, and interventional versus diagnostic procedures.
Results:
A total of 3,761 procedures involving 1,729 patients were included in the study. There was no significant difference between noncardiac and cardiac anesthesia attendings for overall adverse events (odds ratio [OR], 1.2; 95% confidence interval [CI], 0.82 to 1.75 P=0.349). Specific respiratory adverse events (OR, 1.22; 95%, CI 0.73 to 2.03 P=0.443) or cardiac adverse events (OR, 1.26; 95% CI, 0.64 to 2.48 P=0.502) were also not significantly different with respect to noncardiac compared with cardiac attending anesthesiologists.
Conclusions:
In our analysis, the incidence of adverse events in the pediatric cardiac catheterization lab during the study period was not statistically different, whether anesthesia care was provided by a cardiac or a noncardiac anesthesiologist.
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