Description and Management of Cardiac Arrests in Congenital Cardiac Patients Undergoing Cardiac Surgery, Cardiac Catheterization, and Cardiac Imaging

Abstract

Objective: To describe cardiac arrest during anesthesia care provided by a pediatric cardiac anesthesiologist in patients with congenital heart disease and identify predictors of outcome.

Design: Retrospective chart review.

Setting: Quaternary children's hospital.

Participants: Patients with congenital cardiac disease undergoing cardiac procedures or imaging between January 2016 and December 2022 INTERVENTIONS: None.

Measurements and main results: Seventy-six patients experienced cardiac arrest during anesthesia care. The median patient age was 424 days (interquartile range [IQR], 75-4596 days), and the median weight was 7.6 kg (IQR, 4.7-44.1 kg). Twenty-five patients had single ventricle physiology (34%), and 50 patients had normal systemic ventricular function (66%). Cardiac arrest occurred in the cardiac catheterization laboratory in 43 patients (57%) and in the cardiac operating room in 25 patients (33%). Cardiac arrest occurred most frequently during the procedure (n = 60; 79%). The etiology was arrhythmia in 29 patients (38%) and low cardiac output or ischemia in 21 patients (28%). The median duration of cardiopulmonary resuscitation (CPR) was 4 minutes (IQR, 1-11 minutes). Thirty-one patients (44%) received a code dose of epinephrine (10 µg/kg or 1 mg), and 25 patients (33%) required extracorporeal membrane oxygenation (ECMO). Death or neurologic injury within 7 days occurred in 18 patients (24%). On multivariable analysis, only the use of ECMO (adjusted odds ratio, 16, 95% confidence interval, 2.1-93.2; p = 0.006) was independently associated with the composite outcome of neurologic injury or death.

Conclusions: Patients who experienced cardiac arrest while under the care of a pediatric cardiac anesthesiologist had a median CPR duration of 4 minutes. The sole independent predictor of death or neurologic injury within 7 days was the use of ECMO.

Keywords: cardiac arrest; congenital heart disease; pediatric anesthesia.