Related Experiment Videos
Neurologic sequelae of cardiac catheterization
Insights
Pediatric cardiac catheterization can cause neurologic complications. A heparinization protocol significantly reduced these events, preventing strokes and seizures in children undergoing the procedure.
Area of Science:
- Pediatric Cardiology
- Neurology
- Interventional Cardiology
Background:
- Neurologic complications are a recognized risk following cardiac catheterization in children.
- These events can range from seizures to focal neurologic deficits and stroke.
- Understanding contributing factors is crucial for prevention strategies.
Purpose of the Study:
- To identify risk factors for neurologic complications in pediatric cardiac catheterization.
- To evaluate the effectiveness of a heparinization protocol in preventing these adverse events.
Main Methods:
- Retrospective analysis of 1,362 pediatric cardiac catheterizations (age < 15) over four years.
- Comparison of 18 children with neurologic sequelae to matched controls.
- Prospective observation after implementing a heparinization protocol.
Main Results:
- Neurologic complications occurred in 1.3% (18/1,362) of pediatric patients.
- Factors associated with complications included intracatheterization neurologic events and greater hematocrit changes.
- No neurologic complications were observed in the three years following the heparinization protocol.
Conclusions:
- Intracatheterization events and hematocrit shifts are linked to neurologic complications.
- A heparinization protocol appears effective in preventing neurologic sequelae post-cardiac catheterization.
- This strategy may reduce the risk of thromboembolic events in pediatric patients.
Abstract:
Neurologic complications are a known and at times tragic consequence of cardiac catheterization. During a four-year period, 1,362 procedures were performed at our institution on children less than 15 years of age. Eighteen children, without prior nervous system disease, developed neurologic sequelae within 24 hours of cardiac catheterization (1.3%). Three presented with seizures only, ten with neurologic deficits, and five with both focal seizures and stroke. Computerized tomography scans (16 patients) demonstrated areas of nonhemorrhagic infarction in all but one. The 18 patients were studied retrospectively for possible factors contributing to the neurologic complications. They were matched to controls by age, cardiac lesion, and catheterization technique. Data examined included catheterization duration and approach, contrast agent, precatheterization urine specific gravity, pre- and postcatheterization hematocrit, blood loss, and intracatheterization events. Catheter and catheter sheath clots were noted in both patient groups. The neurologic complication group had 7/18 intracatheterization neurologic events versus only one in the controls and the change in hematocrit was greater in the complication group (t = 2.89, p less than 0.01). Due to this study's results and to prevent possible thromboembolic events, a heparinization protocol was instituted and patients were prospectively observed for neurologic complications. No neurologic complications have occurred over three years since the institution of this protocol.