Abstract 17761: Incidence, Risk Factors and Outcomes of Cardiac Arrest/Extracorporeal Life Support Following Stage I Palliation
Study rationale: First stage single ventricle palliation (S1P) confers a high risk for postoperative cardiac arrest (CA). Risk factors for CA and associated outcomes have not been described in the era of the Hybrid procedure (HP).
Methods: Retrospective single center review of all patients who underwent S1P between 2004 - 2011 in a large pediatric cardiovascular and extracorporeal life support (ECLS) program; only patients destined for single ventricle palliation were included. Baseline characteristics, operative, pre-CA, CA and post-CA variables were analyzed by univariable methods. Three distinct multivariable models were constructed to predict baseline risk factors for CA as well as peri- and post-CA predictors of survival to Stage 2 completion (S2).
Results: A total of 123 neonates underwent S1P; 73 (59%) underwent a Norwood procedure (NP) and 50 (41%) underwent a HP. Baseline characteristics were comparable regardless of surgical approach. Twenty-four (19%) neonates had a postoperative CA; 9 (38%) had return of circulation (ROC); most CA occurred within the first 4 days (48%). Median duration of resuscitation (CPR) was 21 minutes and peak post resuscitation lactate was 9.3mmol/L. ECLS was used in 19 (15%) patients; 15 after CPR. There was no difference in CA incidence when comparing NP (15 (21%)) vs HP (9 (23%); p=0.81). Multivariable baseline risk factor for cardiac arrest was operative weight (HR: 0.9; p=0.02 per 200g increase in weight over 2kg); pre-arrest parameters such as arterial blood pressure, lactate, mixed venous saturation and arterio-venous saturation difference were poor predictors of impending CA. Vasoactive inotrope score at CA was negatively associated with S2 (EST -0.24 SE 0.12, p=0.04 per 5 unit increase). Peak lactate post-CA was associated with S2 (OR: 0.58, p=0.02 per 1 mmoL/L increase). Overall 88 (72%) completed S2; odds of completing S2 were decreased by CA (OR 0.19, p<0.001), but increased in this group if there was ROC (OR 12.8, p=0.01).
Conclusion: Cardiac arrest after S1P is relatively common regardless of approach and has high prognostic value for mortality despite use of aggressive resuscitative measures. Operative weight is the greatest predictor of CA; both CA and lack of ROC portend poorly for successful completion of S2.
- Cardiac arrest
- Congenital heart surgery
- Extracorporeal circulation
- Hypoplastic left heart
- Single ventricle
- © 2012 by American Heart Association, Inc.