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Incidence of High Severity Anesthesia Related Adverse Events With Increasing PREDIC3T Risk Category in Congenital
Kristin Chenault1, Grace R Rahman2, Kimberlee Gauvreau2
1Department of Anesthesiology and Pain Medicine, Nationwide Children's Hospital, Columbus, Ohio, USA.
Insights
High severity anesthesia-related adverse events (ARAE) in pediatric cardiac catheterization increase with higher Procedural Risk in Congenital Cardiac Catheterization (PREDIC³T) risk categories. Patient factors like low weight and hemodynamic vulnerability also elevate risks.
Area of Science:
- Pediatric Anesthesiology
- Congenital Heart Disease
- Cardiac Catheterization
Background:
- Anesthesia is crucial for pediatric congenital heart disease (CHD) patients undergoing cardiac catheterization.
- Procedures have shifted from diagnostic to complex interventions, requiring anesthesiologist expertise.
- Anesthesia-related adverse events (ARAE) are a concern in this vulnerable population.
Purpose of the Study:
- To determine the incidence of high severity ARAE in pediatric cardiac catheterization.
- To assess the correlation between ARAE rates and the Procedural Risk in Congenital Cardiac Catheterization (PREDIC³T) risk categories.
- To identify patient and procedural factors associated with high severity ARAE.
Main Methods:
- Multicenter retrospective cohort study using prospective data from the Congenital Cardiac Catheterization Project on Outcomes (C3PO).
- Analysis of 38,021 cardiac catheterizations from 18 institutions (2019-2023).
- Stratification of 17 specific ARAE rates by PREDIC³T risk categories.
Main Results:
- Overall ARAE rate was 0.8%, with high severity ARAE at 0.4%.
- High severity ARAE rates increased with higher PREDIC³T risk categories (0.2% to 0.8%).
- Factors associated with high severity ARAE included weight <10kg, hemodynamic vulnerability score ≥1, and PREDIC³T category 5 procedures.
Conclusions:
- Higher PREDIC³T risk categories are associated with increased rates of high severity ARAE.
- Both patient-specific factors and procedural characteristics influence ARAE in pediatric cardiac catheterization.
- Risk stratification tools are essential for managing anesthesia safety in complex pediatric cardiac procedures.
Background:
Safe and effective anesthesia is critical for the care of pediatric patients with congenital heart disease undergoing cardiac catheterization. Over the past two decades, there has been a significant transition from primarily diagnostic procedures to complex interventional cases, accompanied by a shift from operator-managed sedation to anesthesia administered by a trained anesthesiologist.
Aims:
The aim of our study is to explore the incidence of high severity anesthesia related adverse events (ARAE) and whether these rates correlate with Procedural Risk in Congenital Cardiac Catheterization (PREDIC3T) case-type risk categories. Higher risk categories have been shown to correlate with high severity procedural related adverse events.
Methods:
A multicenter, retrospective cohort study utilized data collected prospectively in the Congenital Cardiac Catheterization Project on Outcomes (C3PO). This study, encompassing 18 contributing institutions, analyzed data from January 1, 2019 to December 31, 2023. Rates of 17 specific ARAE were stratified via PREDIC3T category.
Results:
During the study period, 38, 021 cardiac catheterizations were included in this analysis. A total of 321 ARAE of any severity (level 1-5) were recorded, for an overall rate of 0.8% (CI, 0.7%-0.9%). Of these 321 ARAE, 160 were high severity (level 3bc/4/5), yielding a rate of 0.4%. Rates of high severity ARAE by PREDIC3T risk category (0,1, 2, 3, 4, 5) were found to be 0.2%. 0.4%, 0.5%, 0.3%. 0.8%, and 0.7%, respectively. Multivariable logistic regression analyses identified weight under 10 kg, hemodynamic vulnerability score (HVS) ≥ 1, and PREDIC3T risk category 5 procedures as factors associated with higher odds of experiencing a high severity ARAE.
Conclusions:
The overall rate of ARAE, including high severity ARAE, was found to be increased in higher PREDIC3T risk category procedures. Both patient and procedural factors contribute to ARAE in the congenital cardiac catheterization laboratory.
Clinical Trial Number And Registry:
Not applicable.
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