Abstract 18300: Cardiac Arrest in the Pediatric Post-Operative Cardiac Population: An Opportunity to Further Enhance PALS Guidelines
Introduction: Despite cardiopulmonary arrest (CPA) occurring 10 times more frequently in children admitted to pediatric intensive care units with cardiac disease than other diagnoses, there is a paucity of data regarding patient and procedure-specific parameters or use of real-time feedback during CPA.
Hypothesis: Using our pediatric CPA database, we describe patient, procedure and resuscitative variables related to CPA following congenital heart disease (CHD) surgery.
Methods: Children < 21 years requiring cardiopulmonary bypass (CPB) were reviewed and those experiencing CPA in the post-operative period were identified. Parameters from pre, intra and post-arrest resuscitation periods were analyzed.
Results: Of 461 consecutive CPB, 28/461 (6%) had a CPA within 30 days of the procedure in 27 patients. Six patients had >1 event, for a total of 34 CPA events. CPA occurred < 24 hours post-CPB in 15/28 (54%) with 10/15 (67%) of procedures being STAT 4 or 5 category (90% of which involved placement of shunts or conduits during the corresponding operative event). The sternum remained open at the time of CPA in 10/34 (29%), with 75% open following STAT 4 or 5 procedures. Arterial line was in place at time of CPA for 26/34 (76%) events. Weight at time of CPA was <5 kg for 17/28 (61%). Mean duration of CPA was 14 minutes. In 94% of CPA events (32/34) return of circulation was achieved, with 5/32 (16%) requiring ECPR to do so. Survival to hospital discharge was achieved in 18/27 patients (67%), with 5/8 (63%) surviving following STAT 5 procedures. Post-op CPA occurred equally in males and females, but 7/9 (78%) of those who died before hospital discharge were male. Of those surviving to hospital discharge, 17/18 (94%) had return to neurologic baseline at time of discharge.
Conclusions: Rate of CPA in the postoperative CHD child is high but outcomes can be good. The majority of post-CPB CPAs occurred within 24 hours of surgery and the majority of those had STAT 4 or 5 procedures. Goal directed CPR utilizing arterial lines is not covered in current guidelines but offers the chance to optimize outcomes, particularly in the patient with an open sternum. Important data is available regarding patient, procedure and resuscitation factors that deserve further analysis to inform future guidelines.
Author Disclosures: K. Nelson McMillan: None. J. Duval-Arnould: None. K. Brown: None. L. McNamara: None. D. Alejo: None. M. Machado Alvarez: None. N. Hibino: None. L.A. Vricella: None. D.H. Shaffner: None. E.A. Hunt: None.
- © 2016 by American Heart Association, Inc.