Contrast administration in pediatric cardiac catheterization: dose and adverse events

Abstract

Background: In pediatrics, contrast-related AE such as allergic reactions, seizures, and nephropathy have been reported to occur after cardiac catheterization, but their incidence remains unknown.

Objective: We sought to report adverse event (AE) rates attributed to contrast administration in a pediatric cardiac catheterization lab and identify characteristics related to higher doses.

Methods: A single institution prospective cardiac catheterization AE database identified AE in children <18 years old exposed to contrast. All AE were reviewed and classified by relationship to contrast. Medical records for the 50 cases who received highest contrast doses were retrospectively reviewed for AE. Patient and procedural characteristics were compared in the top quartile of contrast dose versus remaining cases.

Results: Over 3 years, 2,321 consecutive cases required median 3.9 cm(3)/kg [IQR: 2.0, 6.0] of contrast. Patients receiving high dose contrast (top quartile) were more likely to be <1 year (51% vs. 24%), weigh <10 kg (66% vs. 29%), have complex 2 ventricle disease (56% vs. 35%), be in a high procedure type risk group (57% vs. 26%), and undergo procedures >2 h (67% vs. 28%), all P < 0.001. Only 2 of 2,321 cases (0.09%, 95% CI 0.01-0.31%) had AE possibly related to contrast. These events were an acute neurological change and transient nephropathy. In 50 cases receiving the most contrast, no AE were attributed to contrast.

Conclusion: A large volume pediatric cardiac catheterization lab administered >or= 6 cm(3)/kg of contrast in a quarter of cases; however, AE related to contrast exposure were exceedingly rare.

Fig. 1.

Contrast dose in cm3/kg versus the number of cases, with number of patients annotated and the arrow separating the top quartile of contrast administration (n = 580).