You are sent down to the pediatric cardiac catheterization laboratory to provide anesthesia for a child undergoing either an interventional or a diagnostic procedure. How often might these patients experience cardiac arrest? Is the incidence the same as patients undergoing pediatric cardiac surgery?
Dr. Kirsten C. Odegard, MD, Department of Cardiac Anesthesia, Boston Children’s Hospital, Boston, MA and colleagues collected information from cardiac arrests occurring during cardiac catheterization procedures at their hospital between January 1, 2004, and December 31, 2009. Their results appear in the article “The Frequency of Cardiac Arrests in Patients with Congenital Heart Disease Undergoing Cardiac Catheterization” published in this month’s issue of Anesthesia & Analgesia.
Pediatric cardiac anesthesiologists staffed all of the procedures. To be classified as a cardiac arrest, external chest compressions were required for resuscitation. Over 7,000 procedures were performed during this time period. Cardiac arrest occurred in 70 procedures, 1%. The incidence of cardiac arrest was considerably higher during interventional procedures (58 per 100) compared to biopsy procedures (2 per 100) and diagnostic procedures (10 per 100). Among the interventional procedures, the highest incidence of cardiac arrest was associated with ventricular device closure. Patients less than 1 year of age had the highest incidence of arrest. For about 80% of the procedures associated with cardiac arrest, cardiac anesthesia staff managed sedation or anesthesia whereas for 20%, patients received nurse-managed sedation. Patients managed by the cardiac anesthesia staff were younger and weighed less. The majority of arrests were considered to be procedure related. However, in about 10% of the arrests, the arrest was considered more likely related to anesthesia or sedation. For almost 70% of arrests, resuscitation resulted in a perfusing rhythm. About 25% of the arrests required extracorporeal membrane oxygenation for resuscitation. Emergent procedures in the operating room were required for 7%. Lastly, resuscitation failed in about 5% of cardiac arrests.
Mortality ultimately occurred in almost 20% who arrested, including children successfully resuscitated and transferred from the catheterization laboratory but who died before hospital discharge.
Though the cardiac arrest rate in this study was higher than seen in all children undergoing general anesthesia, the cardiac arrest rate was similar to that seen in children undergoing cardiac surgery in the author’s institution.