TY - JOUR
T1 - Incidence and management of life-threatening adverse events during cardiac catheterization for congenital heart disease
AU - Lin, C. Huie
AU - Hegde, Sanjeet
AU - Marshall, Audrey C.
AU - Porras, Diego
AU - Gauvreau, Kimberlee
AU - Balzer, David T.
AU - Beekman, Robert H.
AU - Torres, Alejandro
AU - Vincent, Julie A.
AU - Moore, John W.
AU - Holzer, Ralf
AU - Armsby, Laurie
AU - Bergersen, Lisa
N1 - Funding Information:
C3PO was supported by grants from the Children’s Heart Foundation and the American Heart Association Pharmaceutical Round Table Award. C. H. Lin was supported in part by NIH NRSA 2-T32-HL007081-32 and a training grant from St. Jude Medical Foundation. The authors thank Gary Piercey for database programming support.
PY - 2014/1
Y1 - 2014/1
N2 - 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.
AB - 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.
KW - Cardiac catheterization and intervention
KW - Cardiac surgery
KW - Congenital heart disease
KW - ECMO
KW - Mortality
UR - http://www.scopus.com/inward/record.url?scp=84893707807&partnerID=8YFLogxK
U2 - 10.1007/s00246-013-0752-y
DO - 10.1007/s00246-013-0752-y
M3 - Article
C2 - 23900744
AN - SCOPUS:84893707807
SN - 0172-0643
VL - 35
SP - 140
EP - 148
JO - Pediatric Cardiology
JF - Pediatric Cardiology
IS - 1
ER -