Intraoperative cardiac arrest in patients undergoing congenital cardiac surgeryCentral MessagePerspective
Morgan L. Brown, MD, PhD,
Steven J. Staffa, MS,
Phillip S. Adams, DO,
Lisa A. Caplan, MD,
Stephen J. Gleich, MD,
Jennifer L. Hernandez, MD,
Martina Richtsfeld, MD,
Lori Q. Riegger, MD,
David F. Vener, MD
Affiliations
Morgan L. Brown, MD, PhD
Division of Cardiac Anesthesia, Department of Anesthesiology, Critical Care and Pain Medicine, Boston Children's Hospital, Boston, Mass; Address for reprints: Morgan L. Brown, MD, PhD, Division of Cardiac Anesthesia, Department of Anesthesiology, Critical Care, and Pain Medicine, Boston Children's Hospital, 300 Longwood Ave, Bader 6, Boston, MA 02115.
Steven J. Staffa, MS
Division of Cardiac Anesthesia, Department of Anesthesiology, Critical Care and Pain Medicine, Boston Children's Hospital, Boston, Mass
Phillip S. Adams, DO
Department of Anesthesiology and Perioperative Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pa
Lisa A. Caplan, MD
Division of Cardiovascular Anesthesia, Department of Anesthesiology, Perioperative and Pain Medicine, Texas Children's Hospital, Houston, Tex
Stephen J. Gleich, MD
Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, Minn
Jennifer L. Hernandez, MD
Department of Anesthesiology and Pain Management, Children's Medical Center of Dallas, Dallas, Tex
Martina Richtsfeld, MD
Department of Anesthesiology, University of Minnesota, Masonic Children's Hospital, Minneapolis, Minn
Lori Q. Riegger, MD
Department of Pediatric Anesthesiology, CS Mott Children's Hospital, Ann Arbor, Mich
David F. Vener, MD
Division of Cardiovascular Anesthesia, Department of Anesthesiology, Perioperative and Pain Medicine, Texas Children's Hospital, Houston, Tex
Objective: To describe intraoperative cardiac arrest in patients undergoing congenital heart surgery. Methods: The Society of Thoracic Surgeons Congenital Heart Surgery Database was queried. Predictors of intraoperative cardiac arrest were assessed using univariate and multivariable analyses. The univariate relationship between intraoperative cardiac arrest was also compared with available outcomes in the database. Results: A total of 92,764 cases had anesthesia adverse event data, and 357 patients (0.38%) had an intraoperative cardiac arrest. Multivariable predictors of an intraoperative cardiac arrest included age (odds ratio [OR], 0.98 per year; 95% confidence interval [CI], 0.97-0.99; P = .036), preoperative cardiac arrest (<48 hours) (OR, 9.6; 95% CI 6.3-14.6, P < .001), preoperative neurologic deficit (OR, 2.0; 95% CI, 1.3-3.1, P = .002), noninsulin-dependent diabetes mellitus (OR, 6.4; 95% CI, 1.9-21.9, P = .003), increasing Society of Thoracic Surgeons-European Association for Cardio-Thoracic Surgery (STAT) category (OR, 2.3 for STAT 5 vs STAT 1; 95% CI, 1.3-3.9, P = .003), urgent (OR, 2.0; 95% CI, 1.6-2.6, P < .001) or emergent surgery (OR, 3.1; 95% CI, 1.9-5.0, P < .001), and increasing length of total operating room time (OR, 1.2 per hour; 95% CI, 1.2-1.3, P < .001). Intraoperative cardiac arrest was associated with a greater 30-day mortality (14.6% vs 1.8%, P < .001). There were more morbidities in the intraoperative cardiac arrest group including postoperative neurologic deficits (12% vs 1.0%, P < .001), multisystem organ failure (5.9% vs 0.7%, P < .001), and greater rates of unplanned reoperation (19.3% vs 5.0%, P < .001) or interventional cardiac catheterization (7% vs 3.2%, P < .001). Conclusions: The incidence of intraoperative cardiac arrest is low; however, it is an important indicator of significant patient perioperative morbidity and mortality.
