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Incidence of Cardiac Arrest and In-Hospital Mortality After Pediatric Congenital Heart Surgery in a Middle-Income
Nophanan Chaikittisilpa1, Ketsiree Tungsawat1, Sirirat Rattana-Arpa1
1Department of Anesthesiology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand.
Insights
Pediatric congenital heart surgery in Thailand showed high rates of cardiac arrest and in-hospital mortality. Factors like delayed arrest, multiple events, and prolonged cardiopulmonary resuscitation increased death risk in these children.
Area of Science:
- Pediatric Cardiac Surgery
- Critical Care Medicine
- Public Health in Middle-Income Countries
Background:
- Congenital heart surgery in children is complex and carries risks.
- Data on cardiac arrest incidence and outcomes in middle-income countries are limited.
- Understanding mortality factors post-cardiac arrest is crucial for improving care.
Purpose of the Study:
- To determine the incidence of cardiac arrest following pediatric congenital heart surgery.
- To report in-hospital mortality rates associated with these events.
- To identify factors linked to mortality after cardiac arrest in this population.
Main Methods:
- Retrospective cohort study in Thailand (2014-2019).
- Included patients under 18 undergoing congenital heart surgery with post-operative cardiac arrest.
- Analyzed patient characteristics, management, and mortality-associated factors.
Main Results:
- Overall incidence of cardiac arrest was 6.0% (116/1,928), with 4.8% in-hospital mortality (93/1,928).
- Higher cardiac arrest incidence observed in neonates, high-risk STAT 5 surgery, and emergent/urgent cases.
- Mortality factors included: arrest after 72 hours (aOR 5.59), multiple arrests (aOR 10.23), and longer CPR duration (aOR 1.03 per minute).
Conclusions:
- Pediatric congenital heart surgery in this middle-income setting had high cardiac arrest and mortality rates.
- The mortality rate following cardiac arrest was notably high.
- Key factors predicting mortality were delayed arrest, recurrent events, and extended cardiopulmonary resuscitation.
Abstract:
Objectives: This study aimed to report the incidence of cardiac arrest and in-hospital mortality after pediatric congenital heart surgery in a middle-income country. Methods: This retrospective cohort study was conducted in Thailand. Patients <18 years of age who underwent congenital heart surgery between 2014 and 2019 and experienced cardiac arrest following surgery during the same hospital stay were included. We examined the characteristics of patients who experienced cardiac arrest and its management to determine the mortality-associated factors following cardiac arrest. Results: Overall, 116 cases of cardiac arrest following 1,928 congenital heart surgery operations were included, which resulted in 93/116 (80%) deaths. The incidence of cardiac arrest and in-hospital mortality per 100 patients (95% confidence interval) were 6.0% [116/1,928 (5.0%-7.2%)] and 4.8% [93/1,928 (4.0%-5.9%)], respectively. The incidence of cardiac arrest was higher in neonates (33.6%, 47/140), high-risk STAT 5 surgery (54.8%, 23/43), and emergent/urgent surgery (25.4%, 81/319). Most cardiac arrests occurred within 24 h (66/116, 57%) and in the intensive care unit (90/116, 78%). The most common cause of cardiac arrest was cardiovascular-related (74.1%, 86/116). Multivariable analysis showed the factors associated with mortality (adjusted odds ratio, [95% confidence interval]) included cardiac arrest after 72 h (5.594 [1.073-29.167]), multiple cardiac arrests (10.231 [1.884-55.566]), and every minute increase in cardiopulmonary resuscitation (1.027 [1.005-1.048]). Conclusions: Congenital heart surgery at our middle income cardiac surgical center was associated with relatively high incidence rates of cardiac arrest and in-hospital mortality, and a very high mortality rate following cardiac arrest. The mortality-associated factors after cardiac arrest were cardiac arrest after 72 h, multiple cardiac arrests, and longer duration of cardiopulmonary resuscitation.
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