Incidence and management of life-threatening adverse events during cardiac catheterization for congenital heart disease. Academic Article uri icon

Overview

abstract

  • Continued advancements in congenital cardiac catheterization and interventions have resulted in increased patient and procedural complexity. Anticipation of life-threatening events and required rescue measures is a critical component to preprocedural preparation. We sought to determine the incidence and nature of life-threatening adverse events in congenital and pediatric cardiac catheterization, risk factors, and resources necessary to anticipate and manage events. Data from 8905 cases performed at the 8 participating institutions of the Congenital Cardiac Catheterization Project on Outcomes were captured between 2007 and 2010 [median 1,095/site (range 133-3,802)]. The incidence of all life-threatening events was 2.1 % [95 % confidence interval (CI) 1.8-2.4 %], whereas mortality was 0.28 % (95 % CI 0.18-0.41 %). Fifty-seven life-threatening events required cardiopulmonary resuscitation, whereas 9 % required extracorporeal membrane oxygenation. Use of a risk adjustment model showed that age <1 year [odd ratio (OR) 1.9, 95 % CI 1.4-2.7, p < 0.001], hemodynamic vulnerability (OR 1.6, 95 % CI 1.1-2.3, p < 0.01), and procedure risk (category 3: OR 2.3, 95 % CI 1.3-4.1; category 4: OR 4.2, 95 % CI 2.4-7.4) were predictors of life-threatening events. Using this model, standardized life-threatening event ratios were calculated, thus showing that one institution had a life-threatening event rate greater than expected. Congenital cardiac catheterization and intervention can be performed safely with a low rate of life-threatening events and mortality; preprocedural evaluation of risk may optimize preparation of emergency rescue and bailout procedures. Risk predictors (age < 1, hemodynamic vulnerability, and procedure risk category) can enhance preprocedural patient risk stratification and planning.

authors

  • Lin, Chun
  • Hegde, Sanjeet
  • Marshall, Audrey C
  • Porras, Diego
  • Gauvreau, Kimberlee
  • Balzer, David T
  • Beekman, Robert H
  • Torres, Alejandro
  • Vincent, Julie A
  • Moore, John W
  • Holzer, Ralf
  • Armsby, Laurie
  • Bergersen, Lisa

publication date

  • July 31, 2013

Research

keywords

  • Cardiac Catheterization
  • Extracorporeal Membrane Oxygenation
  • Heart Defects, Congenital
  • Intraoperative Complications
  • Safety Management

Identity

PubMed Central ID

  • PMC3882522

Scopus Document Identifier

  • 84893707807

Digital Object Identifier (DOI)

  • 10.1007/s00246-013-0752-y

PubMed ID

  • 23900744

Additional Document Info

volume

  • 35

issue

  • 1